Basic Information
| Provider Information | |||||||||
| NPI: | 1417095829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOON | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2854 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344782854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527323333 | ||||||||
| FaxNumber: | 3527322469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 E SILVER SPRINGS BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344706831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527323333 | ||||||||
| FaxNumber: | 3527322469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH1763 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | Z3882 | 01 | FL | BCBS OF FLORIDA | OTHER |