Individual
EVELYN DENISE MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1350 HICKORY ST STE 102, MELBOURNE, FL 32901-3224
(321) 434-3455
(321) 434-3456
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN9332088
FL
363L00000X
Nurse Practitioner
ARNP9332088
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9332088
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021420000
—
FL
01
—
JA626Z
FL MEDICARE
FL
01
—
P02169610
FL RR MEDICARE
FL
Enumeration date
06/07/2017
Last updated
02/21/2026
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