Provider Demographics
NPI:1538843289
Name:MORA OTERO, MORAIMA (FNP)
Entity type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:MORA OTERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 CABO ROJO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8373
Mailing Address - Country:US
Mailing Address - Phone:407-534-9952
Mailing Address - Fax:
Practice Address - Street 1:13340 W COLONIAL DR STE 240
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3978
Practice Address - Country:US
Practice Address - Phone:407-534-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9395777163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health