Provider Demographics
NPI:1629466495
Name:MOSS, JAMAICA (CEO)
Entity Type:Individual
Prefix:
First Name:JAMAICA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W JORDAN ST STE 1J
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1734
Mailing Address - Country:US
Mailing Address - Phone:850-455-1252
Mailing Address - Fax:844-683-8754
Practice Address - Street 1:14 W JORDAN ST STE 1J
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1734
Practice Address - Country:US
Practice Address - Phone:850-455-1252
Practice Address - Fax:844-683-8754
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 175F00000X, 175F00000X, 247000000X
FLRN9546621163W00000X
FL176071247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other