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General NPI Number Information
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NPI Number | 1679796551
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Entity Type | Individual
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Provider Name | AMY LYNN MOORE ND, DOM, AP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 10020 SE 15TH AVE
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City | TRENTON
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State | FL
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Zip | 32693-2558
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Country | US
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Telephone | 321-947-0602
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Fax | 888-264-5749
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Provider Business Mailing Address
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Address Line | 10020 SE 15TH AVE
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City | TRENTON
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State | FL
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Zip | 32693-2558
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Country | US
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Telephone | 321-947-0602
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Fax | 888-264-5749
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 2093
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT00001168
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License Number State | WA
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