Individual
JERRICA CHAMBERS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10909 W LINEBAUGH AVE STE 101, TAMPA, FL 33626-1741
(813) 844-4800
(813) 844-1103
Mailing address
PO BOX 1289, TAMPA, FL 33601-1289
(813) 844-4800
(813) 844-1103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1262
NH
363A00000X
Physician Assistant
Primary
PA9116884
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1262
STATE LICENSE
NH
05
—
3109599
—
NH
Enumeration date
05/04/2017
Last updated
04/10/2024
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