Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 9351747 | FL |
N | 363LC1500X | Nurse Practitioner - Community Health | ARNP9351747 | FL |
NPI | 1902391303 |
---|---|
Provider Name | Ms. Keyshla Valera Moreno |
First Address | Clearwater, FL 33763-2221 |
Second Address | Clearwater, FL 33756-3913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 12/07/2018 |