MEDICARE: MRS. HOLLIE DEBRA MOFFETT ARNP

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	163WS0200X	School Registered Nurse	R39919	NM
2	363LF0000X	Family Nurse Practitioner	ARNP9470855	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP9470855	OTHER	FL	ARNP MEDICAL LICENSE
2	14386497	OTHER	FL	CAQH ID NUMBER

General Provider Information

NPI Number	:	1598176133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLIE DEBRA MOFFETT ARNP

Provider Business Mailing Address
First Line	:	11327 OKEECHOBEE BLVD STE 2&3
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-8724
Country	:	US
Telephone Number	:	561-340-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	11327 OKEECHOBEE BLVD STE 2&3
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-8724
Country	:	US
Telephone Number	:	561-340-1615
Fax Number	:

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

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	01/02/2019

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