Individual
DEANDREA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
379 MACON DR, TITUSVILLE, FL 32780-9106
(321) 890-9737
Mailing address
379 MACON DR, TITUSVILLE, FL 32780-9106
(321) 890-9737
(321) 567-2164
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
95533
FL
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
833025863
—
FL
Enumeration date
10/21/2020
Last updated
10/21/2020
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