Provider Demographics
NPI:1295862829
Name:MOORE, LINDA J (A P)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:A P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 RIVER CROSSING BLVD.
Mailing Address - Street 2:STE #101
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-376-7955
Mailing Address - Fax:727-375-8631
Practice Address - Street 1:9400 RIVER CROSSING BLVD.
Practice Address - Street 2:STE #101
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-376-7955
Practice Address - Fax:727-375-8631
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC003UOtherBLUE CROSS