Provider Demographics
NPI:1376051482
Name:MOON, MARIA ALEXANDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIA ALEXANDRA
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:13985 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0932
Mailing Address - Country:US
Mailing Address - Phone:305-300-0312
Mailing Address - Fax:
Practice Address - Street 1:17235 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4418
Practice Address - Country:US
Practice Address - Phone:305-705-4024
Practice Address - Fax:305-234-8688
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9324964363L00000X
FL9324964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health