Provider Demographics
NPI:1194446385
Name:MORA TEJEDA, IRIS (APRN)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:MORA TEJEDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 W 42ND PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7604
Mailing Address - Country:US
Mailing Address - Phone:786-247-6919
Mailing Address - Fax:
Practice Address - Street 1:603 N FLAMINGO RD STE 357
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1013
Practice Address - Country:US
Practice Address - Phone:954-450-8488
Practice Address - Fax:954-450-8860
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012623363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty