Provider Demographics
NPI:1457547499
Name:MOSLEY, LOURDES A (PA)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:A
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LEARNING WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4178
Mailing Address - Country:US
Mailing Address - Phone:850-644-1802
Mailing Address - Fax:850-644-4251
Practice Address - Street 1:960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4178
Practice Address - Country:US
Practice Address - Phone:850-644-1802
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100055363AM0700X
PA9100055363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical