Healthcare Provider Details

I. General information

NPI: 1396698759
Provider Name (Legal Business Name): SANDRA MOISE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BENEVENTO ST
SAINT CLOUD FL
34771-8034
US

IV. Provider business mailing address

15350 SW 50TH AVENUE RD
OCALA FL
34473-5013
US

V. Phone/Fax

Practice location:
  • Phone: 321-402-6698
  • Fax:
Mailing address:
  • Phone: 321-402-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN9354749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: