Provider Demographics
NPI:1427828599
Name:MORA MACHADO, ELIMERYS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ELIMERYS
Middle Name:
Last Name:MORA MACHADO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1701
Mailing Address - Country:US
Mailing Address - Phone:813-585-6894
Mailing Address - Fax:
Practice Address - Street 1:15503 BEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1701
Practice Address - Country:US
Practice Address - Phone:813-585-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily