Healthcare Provider Details

I. General information

NPI: 1457555807
Provider Name (Legal Business Name): JANICE ANN MOORE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13609 ASPEN AVE
RIVERVIEW FL
33569-9351
US

IV. Provider business mailing address

13609 ASPEN AVE
RIVERVIEW FL
33569-9351
US

V. Phone/Fax

Practice location:
  • Phone: 813-244-0360
  • Fax:
Mailing address:
  • Phone: 813-244-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number43047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: