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General NPI Number Information
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NPI Number | 1386207439
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Entity Type | Individual
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Provider Name | NICOLE MOSOS H.A.S.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 18997 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6735
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Country | US
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Telephone | 352-735-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 W SR 434
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City | LONGWOOD
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State | FL
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Zip | 32779-3694
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Country | US
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Telephone | 407-926-8470
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS-5400
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License Number State | FL
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