Individual
NINA MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
65 EASTWOOD DR, PALM COAST, FL 32164-6160
(317) 294-8164
Mailing address
65 EASTWOOD DR, PALM COAST, FL 32164-6160
(317) 294-8164
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5238743
FL
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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