Individual
ELIZABETH ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1348 S 18TH ST STE 340, FERNANDINA BEACH, FL 32034
(904) 775-5957
(904) 390-7387
Mailing address
411 S 5TH ST, FERNANDINA, FL 32034-3909
(913) 481-9695
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9455814
FL
363LF0000X
Family Nurse Practitioner
53-75887-112
KS
363LF0000X
Family Nurse Practitioner
9455814
FL
Other
Enumeration date
01/09/2013
Last updated
09/16/2020
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