Healthcare Provider Details

I. General information

NPI: 1174418446
Provider Name (Legal Business Name): LUCIANA MOREIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 289
OCOEE FL
34761-3432
US

IV. Provider business mailing address

9941 SUMMERLAKE GROVES ST
WINTER GARDEN FL
34787-4497
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-4765
  • Fax: 321-842-4767
Mailing address:
  • Phone: 774-204-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040479
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11040479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: