Basic Information
| Provider Information | |||||||||
| NPI: | 1013395870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 2ND AVE S | ||||||||
| Address2: | APT 229 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372012100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176287000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 670 GLADES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9475425 | FL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | ARNP9475425 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | Q015560 | 05 | TN | MEDICAID |