Healthcare Provider Details

I. General information

NPI: 1255242293
Provider Name (Legal Business Name): TRISHA L MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 COLLEGE PKWY
GULF BREEZE FL
32563-2717
US

IV. Provider business mailing address

1617 COLLEGE PKWY
GULF BREEZE FL
32563-2717
US

V. Phone/Fax

Practice location:
  • Phone: 417-255-5044
  • Fax:
Mailing address:
  • Phone: 417-255-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberRN9500264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: