Provider Demographics
NPI:1689012163
Name:MOORJANI, SOPHIA B (ARNP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:B
Last Name:MOORJANI
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 1:12809 KITE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2968
Mailing Address - Country:US
Mailing Address - Phone:941-803-8135
Mailing Address - Fax:
Practice Address - Street 1:12809 KITE DRIVE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-803-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9277040363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health