Healthcare Provider Details

I. General information

NPI: 1083531982
Provider Name (Legal Business Name): BEVERLY MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 FRENCH ST
JACKSONVILLE FL
32205-5003
US

IV. Provider business mailing address

1201 LAKE ASBURY DR
GREEN COVE SPRINGS FL
32043-9557
US

V. Phone/Fax

Practice location:
  • Phone: 904-425-9044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA106424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: