Provider Demographics
NPI:1902847056
Name:MOODY, SANDRA HILL (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:HILL
Last Name:MOODY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:SANDRA
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 18868
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32523-8868
Mailing Address - Country:US
Mailing Address - Phone:850-994-5660
Mailing Address - Fax:850-994-5841
Practice Address - Street 1:6715 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5923
Practice Address - Country:US
Practice Address - Phone:850-453-6737
Practice Address - Fax:850-453-1196
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP1243363L00000X
FLARNP9179625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002421500Medicaid
592-10170OtherBCBSAL
LA1532321Medicaid
FLY02ELOtherBCBSFL
FLY02ELOtherBCBSFL
FL002421500Medicaid
LA1532321Medicaid