Provider Demographics
NPI:1598434169
Name:MOORE, HANNAH JULINE (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:JULINE
Last Name:MOORE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-5147
Mailing Address - Country:US
Mailing Address - Phone:412-535-2664
Mailing Address - Fax:
Practice Address - Street 1:2093 HENRY TECKLENBURG DR STE 200E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5742
Practice Address - Country:US
Practice Address - Phone:843-958-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4107363A00000X, 363AS0400X
FL9119883363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant