Provider Demographics
NPI:1639956196
Name:MOODIE, HILLARY MORELL
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:MORELL
Last Name:MOODIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 BANBURY CIR
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-7516
Mailing Address - Country:US
Mailing Address - Phone:941-545-2787
Mailing Address - Fax:
Practice Address - Street 1:4163 BANBURY CIR
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-7516
Practice Address - Country:US
Practice Address - Phone:941-545-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker