MEDICARE: DONNA GAIL MOODY ARNP 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	207N00000X	Dermatology Physician	ARNP1326002	FL
2	363LA2200X	Adult Health Nurse Practitioner	ARNP1326002	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00089075	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1497788467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GAIL MOODY ARNP C

Provider Business Mailing Address
First Line	:	957 E DEL WEBB BLVD STE 101
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6671
Country	:	US
Telephone Number	:	813-634-1484
Fax Number	:	813-435-2023

Provider Business Practice Location Address
First Line	:	957 E DEL WEBB BLVD STE 101
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6671
Country	:	US
Telephone Number	:	813-634-1484
Fax Number	:	813-435-2023

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/28/2015

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Directions to “ DONNA GAIL MOODY ARNP C” Practice Location

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