Individual
MS. MARY SUE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
401 CECIL G COSTIN SR BLVD, PORT ST JOE, FL 32456-1928
(850) 229-1043
Mailing address
11523 SW MCCLELLAN FARM RD, CLARKSVILLE, FL 32430-3043
(850) 899-3191
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9162481
FL
363LF0000X
Family Nurse Practitioner
Primary
APRN9162481
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN9162481
FL
Other
Enumeration date
12/22/2015
Last updated
02/03/2026
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