Provider Demographics
NPI:1093134835
Name:MOORE, CHERYL (LM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WHITCOMB BLVD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2605
Mailing Address - Country:US
Mailing Address - Phone:813-426-2397
Mailing Address - Fax:727-255-5578
Practice Address - Street 1:401 WHITCOMB BLVD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2605
Practice Address - Country:US
Practice Address - Phone:813-426-2397
Practice Address - Fax:727-255-5578
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW291176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife