Provider Demographics
NPI:1841447406
Name:MOSS, CHARLES HARRELSON III (CRNP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HARRELSON
Last Name:MOSS
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4440 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1926
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1825 HURLBURT RD STE 14
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3737
Practice Address - Country:US
Practice Address - Phone:850-610-8820
Practice Address - Fax:844-297-8690
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily