Healthcare Provider Details

I. General information

NPI: 1932712627
Provider Name (Legal Business Name): PORSHA CANZATER MOORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOCTOR CIR
COLUMBIA SC
29203-6502
US

IV. Provider business mailing address

111 DOCTOR CIR
COLUMBIA SC
29203-6502
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax:
Mailing address:
  • Phone: 800-491-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24323
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number218439
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: