Healthcare Provider Details

I. General information

NPI: 1770640807
Provider Name (Legal Business Name): LAURA L MOFFATT ARNP, LMT,CCRN, CPAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 NE 7TH ST
OCALA FL
34470-6315
US

IV. Provider business mailing address

2520 NE 7TH ST
OCALA FL
34470-6315
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-9960
  • Fax:
Mailing address:
  • Phone: 352-369-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA33334
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP1472172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: