Provider Demographics
NPI:1235612771
Name:MORERA, LUIS ENRIQUE (ARNP)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:MORERA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 SW NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2469
Mailing Address - Country:US
Mailing Address - Phone:305-979-7195
Mailing Address - Fax:262-425-8964
Practice Address - Street 1:3228 SW MARTIN DOWNS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2680
Practice Address - Country:US
Practice Address - Phone:772-223-0620
Practice Address - Fax:772-223-0640
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9392136363LF0000X
FLALLERGYTRAINED261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102375000Medicaid
FL14440985OtherCAQH