Provider Demographics
NPI:1598176133
Name:MOFFETT, HOLLIE DEBRA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:DEBRA
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11327 OKEECHOBEE BLVD STE 2&3
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8724
Mailing Address - Country:US
Mailing Address - Phone:561-340-1615
Mailing Address - Fax:
Practice Address - Street 1:11327 OKEECHOBEE BLVD STE 2&3
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8724
Practice Address - Country:US
Practice Address - Phone:561-340-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR39919163WS0200X
FLARNP9470855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9470855OtherARNP MEDICAL LICENSE
FL14386497OtherCAQH ID NUMBER