Healthcare Provider Details

I. General information

NPI: 1629725064
Provider Name (Legal Business Name): JOHN MOSLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N HIGHVIEW AVE
HERNANDO FL
34442-8828
US

IV. Provider business mailing address

160 N HIGHVIEW AVE
HERNANDO FL
34442-8828
US

V. Phone/Fax

Practice location:
  • Phone: 352-586-5013
  • Fax:
Mailing address:
  • Phone: 352-586-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: