Healthcare Provider Details

I. General information

NPI: 1700688181
Provider Name (Legal Business Name): COURTNEY MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 SOUTHPOINT PKWY STE 500
JACKSONVILLE FL
32216-1702
US

IV. Provider business mailing address

8876 A C SKINNER PKWY UNIT 4214
JACKSONVILLE FL
32256-0888
US

V. Phone/Fax

Practice location:
  • Phone: 904-683-9515
  • Fax:
Mailing address:
  • Phone: 631-935-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: