Healthcare Provider Details

I. General information

NPI: 1417801051
Provider Name (Legal Business Name): LAUREN MAE MOORE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15901 BASS RD STE 108
FORT MYERS FL
33908-3838
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6050
  • Fax:
Mailing address:
  • Phone: 239-343-6050
  • Fax: 239-343-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: