Individual
DANIELLE MARIE MOSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1401
(321) 434-1667
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1401
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9105821
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011923300
—
FL
01
—
EI889V
MEDICARE
FL
01
—
EI889W
MEDICARE
FL
01
—
P01574599
FL RR
FL
Enumeration date
12/09/2010
Last updated
03/10/2020
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