Provider Demographics
NPI:1386104370
Name:MOSES, TAMELA PATRICIA
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:PATRICIA
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 GEORGIA ST NE STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2565
Mailing Address - Country:US
Mailing Address - Phone:321-465-2288
Mailing Address - Fax:
Practice Address - Street 1:1563 GEORGIA ST NE STE 3
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2565
Practice Address - Country:US
Practice Address - Phone:321-205-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235330364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health