Healthcare Provider Details

I. General information

NPI: 1255030961
Provider Name (Legal Business Name): ALINE HENDRICKSEN-MOISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 DAVIS RD
WEST PALM BEACH FL
33406-5640
US

IV. Provider business mailing address

PO BOX 734951
CHICAGO IL
60673-4951
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: