Provider Demographics
NPI:1386058717
Name:MOORE, JOYCE MARIE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17511 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3211
Mailing Address - Country:US
Mailing Address - Phone:813-915-5459
Mailing Address - Fax:813-971-5468
Practice Address - Street 1:17511 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3211
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:813-971-5468
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9415242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150449AMedicaid
GA202I503290Medicare PIN