Provider Demographics
NPI:1821416488
Name:MOORE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MOORE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:772-220-0033
Mailing Address - Street 1:816 SE OCEAN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2428
Mailing Address - Country:US
Mailing Address - Phone:772-220-0033
Mailing Address - Fax:772-220-0036
Practice Address - Street 1:816 SE OCEAN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2428
Practice Address - Country:US
Practice Address - Phone:772-220-0033
Practice Address - Fax:772-220-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9166216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y068DXMedicare UPIN