Healthcare Provider Details

I. General information

NPI: 1528143765
Provider Name (Legal Business Name): ANN L. MORIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

8620E COUNTY ROAD 466
THE VILLAGES FL
32162-3670
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-4984
  • Fax: 352-392-5376
Mailing address:
  • Phone: 352-399-7295
  • Fax: 352-399-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: