Healthcare Provider Details

I. General information

NPI: 1649654203
Provider Name (Legal Business Name): DENITA RAYMONDE MOORER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 112
JACKSONVILLE FL
32207-8204
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5996
  • Fax: 904-398-2480
Mailing address:
  • Phone: 904-398-3760
  • Fax: 904-398-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9344512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: