Provider Demographics
NPI:1285304725
Name:MOSS, ROSTON T JR (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:ROSTON
Middle Name:T
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3105 NW 107TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2215
Mailing Address - Country:US
Mailing Address - Phone:954-324-7650
Mailing Address - Fax:305-703-2202
Practice Address - Street 1:3105 NW 107TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2215
Practice Address - Country:US
Practice Address - Phone:954-324-7650
Practice Address - Fax:305-703-2202
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health