Provider Demographics
NPI:1437397684
Name:MOORE, VIVIAN S (ARNP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:HOSPITALIST GROUP
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-4996
Mailing Address - Fax:850-431-6315
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:HOSPITALIST GROUP
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-4996
Practice Address - Fax:850-431-6315
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP624592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner