Provider Demographics
NPI:1245415090
Name:MOYER, NINA M (PHD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:M
Last Name:MOYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:M
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:160 CYPRESS POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8433
Mailing Address - Country:US
Mailing Address - Phone:904-662-7800
Mailing Address - Fax:
Practice Address - Street 1:160 CYPRESS POINT PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8433
Practice Address - Country:US
Practice Address - Phone:904-662-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6165101YM0800X, 101YA0400X
OHC.1300158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH6165OtherBOARD OF PROFESSIONAL REGULATION