MEDICARE: MRS. SHERRI LYNN MORAN SUPERV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063736247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRI LYNN MORAN SUPERV

Provider Business Mailing Address
First Line	:	203 N ARMENIA AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2383
Country	:	US
Telephone Number	:	813-281-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 E FOWLER AVE
Second Line	:	HEALTHY FAMILIES PROGR
City	:	TAMPA
State	:	FL
Zip	:	33612-5413
Country	:	US
Telephone Number	:	813-558-1077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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