Healthcare Provider Details

I. General information

NPI: 1043010911
Provider Name (Legal Business Name): GEORGE MOYET-MELENDEZ REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 CYPRESS RIDGE BLVD STE 101
WESLEY CHAPEL FL
33544-6305
US

IV. Provider business mailing address

5275 POST OAK BLVD APT 109
WESLEY CHAPEL FL
33544-5612
US

V. Phone/Fax

Practice location:
  • Phone: 813-803-2972
  • Fax:
Mailing address:
  • Phone: 813-803-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299996292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: