Healthcare Provider Details

I. General information

NPI: 1154342426
Provider Name (Legal Business Name): STEPHANIE R. MOSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE CENTRAL 766 (D39)
MIAMI FL
33136-1005
US

IV. Provider business mailing address

9915 NW 20TH ST
PEMBROKE PINES FL
33024-1443
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5535
  • Fax: 305-585-8109
Mailing address:
  • Phone: 954-443-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2159342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: