Healthcare Provider Details

I. General information

NPI: 1982955506
Provider Name (Legal Business Name): DONNA LYNN MOORE ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA LYNN MOORE MOORE

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 TARA BLVD STE 103
BRADENTON FL
34203-8865
US

IV. Provider business mailing address

6144 9TH AVENUE CIR NE
BRADENTON FL
34212-9559
US

V. Phone/Fax

Practice location:
  • Phone: 941-254-0861
  • Fax:
Mailing address:
  • Phone: 941-254-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: