MEDICARE: NICOLE MOSLEY NP

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	363L00000X	Nurse Practitioner	RN198743	GA

General Provider Information

NPI Number	:	1700324043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MOSLEY NP

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST FL 7
Second Line	:	HCR MANORCARE MEDICAL SERVICES OF FLORIDA LLC
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:	419-252-6031
Fax Number	:	800-564-5952

Provider Business Practice Location Address
First Line	:	4360 JOHNSON FERRY PL
Second Line	:	HEARTLAND CARE PARTNERS
City	:	MARIETTA
State	:	GA
Zip	:	30068-2063
Country	:	US
Telephone Number	:	800-427-1902
Fax Number	:	419-531-2264

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	03/14/2017

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