Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 9218485 | FL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 9218485 | FL |
NPI | 1003219056 |
---|---|
Provider Name | Ms. Shelly Amanda Mosely |
First Address | Stuart, FL 34997-6396 |
Second Address | Port St Lucie, FL 34952-7168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 11/02/2022 |