Healthcare Provider Details

I. General information

NPI: 1619946050
Provider Name (Legal Business Name): BEVERLY V MOORE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 NW 23RD AVE
GAINESVILLE FL
32606-6541
US

IV. Provider business mailing address

13554 NW 7TH RD
NEWBERRY FL
32669-4457
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 352-339-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1103992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: