Healthcare Provider Details

I. General information

NPI: 1346177292
Provider Name (Legal Business Name): KEISHA LASHAWN MOSS APRN, FNP- BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 NW 207TH STREET RD
MIAMI GARDENS FL
33055-1140
US

IV. Provider business mailing address

3863 NW 207TH STREET RD
MIAMI GARDENS FL
33055-1140
US

V. Phone/Fax

Practice location:
  • Phone: 786-647-4030
  • Fax:
Mailing address:
  • Phone: 786-647-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11046696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: