Provider Demographics
NPI:1689063562
Name:MOSLEY, MISTY (BS)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MARIE
Other - Last Name:AXLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:10634 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6847
Mailing Address - Country:US
Mailing Address - Phone:407-687-1927
Mailing Address - Fax:
Practice Address - Street 1:250 WILSHIRE BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5377
Practice Address - Country:US
Practice Address - Phone:407-951-8539
Practice Address - Fax:407-960-3850
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator