MEDICARE: ANDRISE MOROSE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	GAA-NP000470	GA

General Provider Information

NPI Number	:	1588317176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRISE MOROSE NP

Provider Business Mailing Address
First Line	:	5995 COVERED CREEK LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5995 COVERED CREEK LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1450
Country	:	US
Telephone Number	:	904-993-2797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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