Individual
JENNIFER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6187
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6187
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3401
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290371700
—
FL
01
—
970004474
RAILROAD MEDICARE
FL
Enumeration date
06/22/2005
Last updated
03/31/2011
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