| Moore Medical Group Inc | |
|
801 International Pkwy Ste 500 Lake Mary FL 32746-4763 | |
| (407) 493-3549 | |
| Not Available |
| Full Name | Moore Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 801 International Pkwy Ste 500, Lake Mary, Florida |
| Authorized Official Name and Position | Eric A Moore (CEO/ CJIEF MEDICAL OFFICER) |
| Authorized Official Contact | 4074963549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Medical Group Inc 801 International Pkwy Ste 500 Lake Mary FL 32746-4763 Ph: (407) 493-3549 | Moore Medical Group Inc 801 International Pkwy Ste 500 Lake Mary FL 32746-4763 Ph: (407) 493-3549 |
| NPI Number | 1871117572 |
|---|---|
| Provider Enumeration Date | 05/29/2020 |
| Last Update Date | 05/29/2020 |
| Certification Date | 05/29/2020 |
| Medicare PECOS PAC ID | 9638354889 |
|---|---|
| Medicare Enrollment ID | O20200911000247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871117572 | NPI | - | NPPES |
| Provider Name | Krishna Uppu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265567325 PECOS PAC ID: 1052365608 Enrollment ID: I20050308000340 |
| Provider Name | Elizabeth S Collie-mickens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356578348 PECOS PAC ID: 7810163078 Enrollment ID: I20120110000594 |
| Provider Name | Lyntressa Danielle Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083955793 PECOS PAC ID: 3375784911 Enrollment ID: I20130724000965 |
| Provider Name | Joanna Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558791434 PECOS PAC ID: 8325359565 Enrollment ID: I20150615002467 |
| Provider Name | Marie M Collazo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346640356 PECOS PAC ID: 3476863994 Enrollment ID: I20151112000504 |
| Provider Name | Estherline Exume-noel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437518933 PECOS PAC ID: 1052677697 Enrollment ID: I20171114002671 |
| Provider Name | Sarah Slone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225501653 PECOS PAC ID: 8022356179 Enrollment ID: I20190214002062 |
| Provider Name | Millian Okafor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114403631 PECOS PAC ID: 5193152619 Enrollment ID: I20200224000610 |
| Provider Name | Tiffany Cappelen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043779549 PECOS PAC ID: 0840680435 Enrollment ID: I20211214003210 |
| Provider Name | Yiny Poveda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396166849 PECOS PAC ID: 8022489095 Enrollment ID: I20230130002725 |
| Provider Name | Edward Kuhnley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366443434 PECOS PAC ID: 2668494972 Enrollment ID: I20240219002876 |
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