Healthcare Provider Details

I. General information

NPI: 1609739721
Provider Name (Legal Business Name): MOYA-PRIDA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 S TAMIAMI TRL STE 116
FORT MYERS FL
33908-4235
US

IV. Provider business mailing address

1460 S PALM AVE
PEMBROKE PINES FL
33025-5520
US

V. Phone/Fax

Practice location:
  • Phone: 954-239-7486
  • Fax: 954-376-7289
Mailing address:
  • Phone: 954-239-7486
  • Fax: 954-376-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYNIER MOYA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-239-7486