Individual
JACK WALTER MORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8251 PATHFINDER LOOP APT 617, FORT MYERS, FL 33919-8793
(239) 322-7732
Mailing address
8251 PATHFINDER LOOP APT 617, FORT MYERS, FL 33919-8793
(239) 322-7732
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9555145
FL
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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