Healthcare Provider Details

I. General information

NPI: 1285556902
Provider Name (Legal Business Name): PATRICE MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 VISTA PKWY
WEST PALM BEACH FL
33411-2719
US

IV. Provider business mailing address

2085 VISTA PKWY
WEST PALM BEACH FL
33411-2719
US

V. Phone/Fax

Practice location:
  • Phone: 615-424-9913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN9612466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: