Healthcare Provider Details

I. General information

NPI: 1013395870
Provider Name (Legal Business Name): ELIZABETH MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

IV. Provider business mailing address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-9511
  • Fax:
Mailing address:
  • Phone: 561-495-9511
  • Fax: 561-990-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9475425
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9475425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: