Provider Demographics
NPI:1417282542
Name:MOORE, STEPHANIE REBEKAH (MSN, ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REBEKAH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20615 AMBERFIELD DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4387
Mailing Address - Country:US
Mailing Address - Phone:813-949-2950
Mailing Address - Fax:813-949-2924
Practice Address - Street 1:20615 AMBERFIELD DR
Practice Address - Street 2:#102
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4387
Practice Address - Country:US
Practice Address - Phone:813-949-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9352274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily