MEDICARE: HEATHER MARIE MOODY III 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	363LF0000X	Family Nurse Practitioner	ARNP9198659	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851431050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE MOODY III ARNP

Provider Business Mailing Address
First Line	:	1702 COTTAGE WAY CT
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2658
Country	:	US
Telephone Number	:	813-493-2664
Fax Number	:

Provider Business Practice Location Address
First Line	:	4238 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2231
Country	:	US
Telephone Number	:	813-870-2528
Fax Number	:	813-876-5462

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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