Provider Demographics
NPI:1154531796
Name:MORA, JOANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:MORA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CLYDE MORRIS BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3196
Mailing Address - Country:US
Mailing Address - Phone:386-672-3219
Mailing Address - Fax:386-672-3160
Practice Address - Street 1:335 CLYDE MORRIS BLVD STE 290
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3196
Practice Address - Country:US
Practice Address - Phone:386-672-3219
Practice Address - Fax:386-672-3160
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7808363A00000X
FLPA9118802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102003OtherFLORIDA LICENSE NUMBER