Provider Demographics
NPI:1679796551
Name:MOORE, AMY LYNN (ND, DOM, AP)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:ND, DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-2558
Mailing Address - Country:US
Mailing Address - Phone:321-947-0602
Mailing Address - Fax:888-264-5749
Practice Address - Street 1:10020 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-2558
Practice Address - Country:US
Practice Address - Phone:321-947-0602
Practice Address - Fax:888-264-5749
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2093171100000X
WANT00001168175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath