Provider Demographics
NPI:1588632210
Name:MOORMAN, ELAINE E (ARNP, DHSC)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:E
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:ARNP, DHSC
Other - Prefix:PROF
Other - First Name:ELAINE
Other - Middle Name:E
Other - Last Name:MOOMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:32648 DARBY ROAD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525
Mailing Address - Country:US
Mailing Address - Phone:352-748-0283
Mailing Address - Fax:352-748-0117
Practice Address - Street 1:411 N. WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:352-748-6689
Practice Address - Fax:352-748-6381
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL728402363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7190OtherBCBS
FL300313200Medicaid
FLY7190WMedicare PIN
FLY7190ZMedicare PIN
FLY7190VMedicare PIN