Healthcare Provider Details

I. General information

NPI: 1265303531
Provider Name (Legal Business Name): AMY JEAN MORAN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W BAY AVE
LONGWOOD FL
32750-4125
US

IV. Provider business mailing address

231 W BAY AVE
LONGWOOD FL
32750-4125
US

V. Phone/Fax

Practice location:
  • Phone: 407-554-5804
  • Fax: 407-214-3171
Mailing address:
  • Phone: 407-554-5804
  • Fax: 407-214-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: