Healthcare Provider Details

I. General information

NPI: 1497788467
Provider Name (Legal Business Name): DONNA GAIL MOODY ARNP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 E DEL WEBB BLVD STE 101
SUN CITY CENTER FL
33573-6671
US

IV. Provider business mailing address

957 E DEL WEBB BLVD STE 101
SUN CITY CENTER FL
33573-6671
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-1484
  • Fax: 813-435-2023
Mailing address:
  • Phone: 813-634-1484
  • Fax: 813-435-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberARNP1326002
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP1326002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: