MEDICARE: JESSICA MOORE

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	237700000X	Hearing Instrument Specialist	AS5688	FL

General Provider Information

NPI Number	:	1104684984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MOORE

Provider Business Mailing Address
First Line	:	10929 S US HIGHWAY 1
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6417
Country	:	US
Telephone Number	:	772-337-2526
Fax Number	:

Provider Business Practice Location Address
First Line	:	10929 S US HIGHWAY 1
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6417
Country	:	US
Telephone Number	:	772-337-2526
Fax Number	:

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

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ JESSICA MOORE ” Practice Location

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