Individual
MRS. STACEY BRIGHAM MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4321 NW STATE ROAD 270, BRISTOL, FL 32321-2303
(850) 567-2095
Mailing address
4321 NW STATE ROAD 270, BRISTOL, FL 32321-2303
(850) 567-2095
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
DC
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
10/19/2017
Last updated
10/23/2017
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