MEDICARE: DARRA S MOORE R.N.

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	163WC0400X	Case Management Registered Nurse	RN2829392	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN2829392	OTHER	FL	RN LICENSE

General Provider Information

NPI Number	:	1902134091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRA S MOORE R.N.

Provider Business Mailing Address
First Line	:	6055 RAND BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-5189
Country	:	US
Telephone Number	:	941-361-6250
Fax Number	:	941-361-6272

Provider Business Practice Location Address
First Line	:	1750 17TH ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-8632
Country	:	US
Telephone Number	:	941-861-1400
Fax Number	:

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

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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