Provider Demographics
NPI:1376051482
Name:MOON, MARIA ALEXANDRA (ARNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIA ALEXANDRA
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:6615 HILLWAY CIR STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-8755
Practice Address - Country:US
Practice Address - Phone:239-315-7541
Practice Address - Fax:239-315-7542
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9324964363LF0000X
FL9324964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health