Provider Demographics
NPI:1801344668
Name:MOISE, ARETHEA TAMARA (ARNP)
Entity type:Individual
Prefix:
First Name:ARETHEA
Middle Name:TAMARA
Last Name:MOISE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ARETHEA
Other - Middle Name:
Other - Last Name:MCBEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:219 BIG SKY DR.
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715
Mailing Address - Country:US
Mailing Address - Phone:352-277-4282
Mailing Address - Fax:
Practice Address - Street 1:1503 BUENOS AIRES BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6821
Practice Address - Country:US
Practice Address - Phone:352-750-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9222104363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health