Healthcare Provider Details

I. General information

NPI: 1013907211
Provider Name (Legal Business Name): MARLA J MOSELEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25188 MARION AVE VILLA 21
PUNTA GORDA FL
33950-4103
US

IV. Provider business mailing address

25188 MARION AVE VILLA 21
PUNTA GORDA FL
33950-4103
US

V. Phone/Fax

Practice location:
  • Phone: 941-575-2918
  • Fax: 941-575-2918
Mailing address:
  • Phone: 941-575-2918
  • Fax: 941-575-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2600532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: