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General NPI Number Information
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NPI Number | 1417924754
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Entity Type | Individual
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Provider Name | TONY L. MOFFITT NP
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3810 DRANE FIELD RD UNIT 15
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City | LAKELAND
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State | FL
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Zip | 33811-1204
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Country | US
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Telephone | 863-646-8468
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Fax | 863-533-0333
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Provider Business Mailing Address
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Address Line | 1624 KING JAMES CT
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City | LAKELAND
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State | FL
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Zip | 33813-2923
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Country | US
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Telephone | 863-670-0114
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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 | ARNP1871332
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License Number State | FL
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