Healthcare Provider Details

I. General information

NPI: 1891372355
Provider Name (Legal Business Name): ERIN ELIZABETH MOFFETT DO, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

V. Phone/Fax

Practice location:
  • Phone: 941-798-6513
  • Fax:
Mailing address:
  • Phone: 727-834-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS22944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: