Provider Demographics
NPI:1730652389
Name:JOSEPH, MOISE (APRN)
Entity Type:Individual
Prefix:
First Name:MOISE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 VIA JARDIN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7838
Mailing Address - Country:US
Mailing Address - Phone:785-985-4049
Mailing Address - Fax:
Practice Address - Street 1:6080 BOYNTON BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3586
Practice Address - Country:US
Practice Address - Phone:561-740-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily