MEDICARE: MOYA STACY HAUGHTON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R251619	MD
2	363LF0000X	Family Nurse Practitioner	F348705-01	NY

General Provider Information

NPI Number	:	1033056387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOYA STACY HAUGHTON FNP-C

Provider Business Mailing Address
First Line	:	P.O BOX 3075
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-9998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	P.O BOX 3075
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-9998
Country	:	US
Telephone Number	:	347-954-6525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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