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Individual

MRS. BERTISHIA LASHANTI MOSLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNA

Contact information

Practice address
2308 FULTON WAY, LARGO, FL 33774
(727) 565-9029
Mailing address
2308 FULTON WAY, LARGO, FL 33774-1517
(727) 565-9029

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
FL
261QD1600X
Developmental Disabilities Clinic/Center
Primary
FL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
022971400
FL
Enumeration date
07/17/2018
Last updated
07/17/2018
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