Provider Demographics
NPI:1053993733
Name:MOODIE, CARYNE (APRN)
Entity type:Individual
Prefix:DR
First Name:CARYNE
Middle Name:
Last Name:MOODIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9687
Mailing Address - Country:US
Mailing Address - Phone:561-294-6776
Mailing Address - Fax:
Practice Address - Street 1:628 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-9687
Practice Address - Country:US
Practice Address - Phone:561-294-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008500261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy