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General NPI Number Information
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NPI Number | 1114775046
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Entity Type | Individual
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Provider Name | TASHA RENAE MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 05/07/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 894 E ALTAMONTE DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5002
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Country | US
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Telephone | 407-834-5151
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Fax | 407-834-5562
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Provider Business Mailing Address
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Address Line | 673 VITTORIO DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3449
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Country | US
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Telephone | 262-744-2115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11032086
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11032086
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License Number State | FL
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