Provider Demographics
NPI:1225627714
Name:MOSLEY, DANA (PA-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:O'SHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:395-615-0502
Mailing Address - Fax:239-343-4241
Practice Address - Street 1:12801 WESTLINKS DR STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8001
Practice Address - Country:US
Practice Address - Phone:239-561-5050
Practice Address - Fax:239-343-4241
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118975400Medicaid