Healthcare Provider Details

I. General information

NPI: 1942118021
Provider Name (Legal Business Name): MAY CAMELIA MOISE-SLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 SOUTHGATE COMMERCE BLVD STE 64
ORLANDO FL
32806-8551
US

IV. Provider business mailing address

1245 SOPHIE BLVD
ORLANDO FL
32828-5919
US

V. Phone/Fax

Practice location:
  • Phone: 321-461-5750
  • Fax:
Mailing address:
  • Phone: 321-461-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: