MEDICARE: SARA DANIELLE MOORE ALLEN APRN

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	363LF0000X	Family Nurse Practitioner	11016941	FL

General Provider Information

NPI Number	:	1427701788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA DANIELLE MOORE ALLEN APRN

Provider Business Mailing Address
First Line	:	756 S ORLANDO AVE APT 115
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-4425
Country	:	US
Telephone Number	:	321-317-5384
Fax Number	:

Provider Business Practice Location Address
First Line	:	661 EYSTER BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8119
Country	:	US
Telephone Number	:	321-637-2755
Fax Number	:	321-636-4157

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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