Healthcare Provider Details

I. General information

NPI: 1467469338
Provider Name (Legal Business Name): BETH ANN-PONTIUS MOORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN PONTIUS

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 DOGWOOD DR
MILTON FL
32570-3546
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 850-665-2080
  • Fax: 850-270-6846
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2734202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: