MEDICARE: MRS. LISA S MOORE ARNP, DNP

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	ARNP9166216	FL

General Provider Information

NPI Number	:	1730240326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA S MOORE ARNP, DNP

Provider Business Mailing Address
First Line	:	4476 LEGENDARY DR STE 100
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-5347
Country	:	US
Telephone Number	:	850-424-7320
Fax Number	:	850-424-7322

Provider Business Practice Location Address
First Line	:	4476 LEGENDARY DR STE 100
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-5347
Country	:	US
Telephone Number	:	850-424-7320
Fax Number	:	850-424-7322

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/02/2026

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