Provider Demographics
NPI:1457555807
Name:MOORE, JANICE ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13609 ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-9351
Mailing Address - Country:US
Mailing Address - Phone:813-244-0360
Mailing Address - Fax:
Practice Address - Street 1:13609 ASPEN AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-9351
Practice Address - Country:US
Practice Address - Phone:813-244-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43047175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath