Healthcare Provider Details

I. General information

NPI: 1851837504
Provider Name (Legal Business Name): MOYETTE P GRAHAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

IV. Provider business mailing address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-6226
  • Fax: 407-438-0507
Mailing address:
  • Phone: 407-851-6226
  • Fax: 407-438-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9258208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: