Provider Demographics
NPI:1093121998
Name:MORECRAFT, DORIT (NP)
Entity Type:Individual
Prefix:
First Name:DORIT
Middle Name:
Last Name:MORECRAFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 MAIN ST # 1044
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3551
Mailing Address - Country:US
Mailing Address - Phone:813-793-7407
Mailing Address - Fax:313-789-1751
Practice Address - Street 1:10641 WHITTINGTON COURT
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:813-793-7407
Practice Address - Fax:313-789-1751
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006983363LA2200X, 363LG0600X, 363LP0808X
FL9492734363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5006983OtherNC LICENSE