Provider Demographics
NPI:1285151233
Name:MOORER, DIANA P (ARNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:MOORER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:PIERRE MOORER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:106 W WINDHORST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2455
Mailing Address - Country:US
Mailing Address - Phone:813-373-9531
Mailing Address - Fax:813-413-4330
Practice Address - Street 1:12200 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2630
Practice Address - Country:US
Practice Address - Phone:813-373-9531
Practice Address - Fax:813-413-4330
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9340864363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health