| Entity Name: | MARIA E. MORA, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Aug 1999 (26 years ago) |
| Document Number: | P99000070113 |
| FEI/EIN Number | 593581047 |
| Address: | 91 BRANSCOMB ROAD, SUITE #3, GREEN COVE SPRINGS, FL, 32043, US |
| Mail Address: | 91 BRANSCOMB ROAD, SUITE #3, GREEN COVE SPRINGS, FL, 32043, US |
| ZIP code: | 32043 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184657306 | 2006-07-09 | 2024-01-06 | 91 BRANSCOMB RD STE 3, GREEN COVE SPRINGS, FL, 320437222, US | 91 BRANSCOMB RD STE 3, GREEN COVE SPRINGS, FL, 320437222, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-861-1034 |
| Fax | 9048611037 |
Authorized person
| Name | MARIA ELENA MORA |
| Role | PRESIDENT |
| Phone | 9048611034 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| License Number | PA9104224 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271515500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MORA MARIA E | Agent | 4443 SUMMER WALK COURT, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| MORA MARIA E | Director | 4443 SUMMER WALK COURT, JACKSONVILLE, FL, 32258 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000131574 | MIDDLEBURG PEDIATRICS | ACTIVE | 2020-10-09 | 2025-12-31 | No data | 91 BRANSCOMB ROAD, SUITE 3, GREEN COVE SPRINGS, FL, 32043 |
| G20000131580 | NORMANDY PEDIATRICS | ACTIVE | 2020-10-09 | 2025-12-31 | No data | 10250 NORMANDY BLVD, #201, JACKSONVILLE, FL, 32221 |
| G09000138804 | NORMANDY PEDIATRICS | EXPIRED | 2009-07-27 | 2014-12-31 | No data | 3839 COUNTY ROAD 218 EAST, SUITE C, MIDDLEBURG, FL, 32068 |
| G09099900285 | MIDDLEBURG PEDIATRICS | EXPIRED | 2009-04-09 | 2014-12-31 | No data | 3839 COUNTY ROAD 218 EAST, SUITE C, MIDDLEBURG, FL, 32068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-16 | 91 BRANSCOMB ROAD, SUITE #3, GREEN COVE SPRINGS, FL 32043 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-16 | 91 BRANSCOMB ROAD, SUITE #3, GREEN COVE SPRINGS, FL 32043 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-07-19 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
