Provider Demographics
NPI:1013907211
Name:MOSELEY, MARLA J (CRNA)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:J
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25188 MARION AVE
Mailing Address - Street 2:VILLA 21
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4103
Mailing Address - Country:US
Mailing Address - Phone:941-575-2918
Mailing Address - Fax:941-575-2918
Practice Address - Street 1:25188 MARION AVE
Practice Address - Street 2:VILLA 21
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4103
Practice Address - Country:US
Practice Address - Phone:941-575-2918
Practice Address - Fax:941-575-2918
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2600532367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3657YOtherMEDICARE