Active NPI
Jessica Mora, ATC, CSCS
- Specialist
- Fort Lauderdale, FL
National Provider Identifier
1417005646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- AL1012
- Practice address
- 5237 SW 40TH Ave
Fort Lauderdale, FL 33314-6501 - Phone
- (305) 298-7966
- Fax
- (954) 584-8190
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | AL1012 | FL | Primary |
Addresses
Primary practice location
5237 SW 40TH Ave
Fort Lauderdale, FL 33314-6501
Mailing address
5237 SW 40TH Ave
Fort Lauderdale, FL 33314-6501
Phone (305) 298-7966
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AL1012 | Other | FL | ATHLETIC TRAINER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL1012 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417005646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5237 SW 40TH AVE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333146501",
"telephone_number": "305-298-7966",
"fax_number": "954-584-8190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5237 SW 40TH AVE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333146501",
"telephone_number": "305-298-7966",
"fax_number": "954-584-8190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "JESSICA",
"credential": "ATC, CSCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "AL1012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "AL1012",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.