Provider Demographics
NPI:1750688180
Name:MOFFAT, ANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 BARLOW TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-7255
Mailing Address - Country:US
Mailing Address - Phone:941-429-0772
Mailing Address - Fax:
Practice Address - Street 1:5353 BARLOW TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7255
Practice Address - Country:US
Practice Address - Phone:941-429-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2959102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse