Individual
MERVIS JACKSON-MOODIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8424 LONG ACRE DR, MIRAMAR, FL 33025-2816
(786) 553-6164
Mailing address
19388 NW 14TH ST, PEMBROKE PINES, FL 33029-3200
(786) 553-6164
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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