Provider Demographics
NPI:1497788467
Name:MOODY, DONNA GAIL (ARNP C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAIL
Last Name:MOODY
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 E DEL WEBB BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6671
Mailing Address - Country:US
Mailing Address - Phone:813-634-1484
Mailing Address - Fax:813-435-2023
Practice Address - Street 1:957 E DEL WEBB BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6671
Practice Address - Country:US
Practice Address - Phone:813-634-1484
Practice Address - Fax:813-435-2023
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1326002207N00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00089075OtherRAILROAD MEDICARE
Q01443Medicare UPIN
FLP00089075OtherRAILROAD MEDICARE