=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588713861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA MOONEY MS, ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 S ALEXANDER ST SUITE 6
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33563-8400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-719-8404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 THOMPSON RD
-----------------------------------------------------
City | LITHIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33547-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | ARNP 1216832
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------