Provider Demographics
NPI:1578396016
Name:MORALES, BRISEIDA JUANITA (LPN, CLC, FSD)
Entity type:Individual
Prefix:
First Name:BRISEIDA
Middle Name:JUANITA
Last Name:MORALES
Suffix:
Gender:F
Credentials:LPN, CLC, FSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2193
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32353-2193
Mailing Address - Country:US
Mailing Address - Phone:850-405-3731
Mailing Address - Fax:
Practice Address - Street 1:19 ACYE LN
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-7877
Practice Address - Country:US
Practice Address - Phone:850-405-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula