Healthcare Provider Details

I. General information

NPI: 1417282542
Provider Name (Legal Business Name): STEPHANIE REBEKAH MOORE MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23520 STATE ROAD 54 STE 102
LUTZ FL
33559-6753
US

IV. Provider business mailing address

23520 STATE ROAD 54 STE 102
LUTZ FL
33559-6753
US

V. Phone/Fax

Practice location:
  • Phone: 813-909-4430
  • Fax: 813-825-0770
Mailing address:
  • Phone: 813-909-4430
  • Fax: 813-825-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9352274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: