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General NPI Number Information
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NPI Number | 1699024562
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MOORE PA
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 5802 E FOWLER AVE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3300
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Country | US
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Telephone | 813-442-7493
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Fax |
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Provider Business Mailing Address
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Address Line | 5802 E FOWLER AVE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3300
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Country | US
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Telephone | 813-442-7493
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9106682
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106682
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License Number State | FL
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