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Organization
TELEPRACTITIONERS
Active
Organization
TELEPRACTITIONERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN MORAN (OWNER)
(813) 735-9164
Entity
Organization
Contact information
Practice address
6440 DEVESTA LOOP, PALMETTO, FL 34221-2373
(813) 735-9164
Mailing address
6440 DEVESTA LOOP, PALMETTO, FL 34221-2373
(813) 735-9164
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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