Healthcare Provider Details

I. General information

NPI: 1891162384
Provider Name (Legal Business Name): CASANDRA MOYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASANDRA MOYER DNP, FNP-BC, PNP

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 NORIEGA ST STE 888
SAN FRANCISCO CA
94122-4239
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 843-474-5578
  • Fax: 843-790-1871
Mailing address:
  • Phone: 843-474-5578
  • Fax: 843-790-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002698
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95002698
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202109748
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95002698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: