Provider Demographics
NPI:1598479172
Name:MORETTI, KARLI LOREN (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:LOREN
Last Name:MORETTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 FONTANA ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5086
Mailing Address - Country:US
Mailing Address - Phone:352-989-0772
Mailing Address - Fax:
Practice Address - Street 1:317 NORTON DR STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5965
Practice Address - Country:US
Practice Address - Phone:850-702-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant