Provider Demographics
NPI:1992148142
Name:MOORE, EVA FLOYD (SENIOR COSMETOLGIST)
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:FLOYD
Last Name:MOORE
Suffix:
Gender:F
Credentials:SENIOR COSMETOLGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15262 TRUMAN MANOR LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-5401
Mailing Address - Country:US
Mailing Address - Phone:240-229-7270
Mailing Address - Fax:
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE A202
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:240-229-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
439785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist