Active NPI
Marianne Moselle
- Contractor
- Lakeland, FL
National Provider Identifier
1154586048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 593286346
- Practice address
- 6652 Glen Meadow Loop
Lakeland, FL 33810-5881 - Phone
- (863) 255-7300
- Fax
- (863) 859-5350
- NPI assigned
- Jul 21, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 593286346 | FL | Primary |
Addresses
Primary practice location
6652 Glen Meadow Loop
Lakeland, FL 33810-5881
Mailing address
6652 Glen Meadow Loop
Lakeland, FL 33810-5881
Phone (863) 607-9611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 67-7735000 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 593286346 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741046400000",
"number": "1154586048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6652 GLEN MEADOW LOOP",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338105881",
"telephone_number": "863-607-9611",
"fax_number": "863-859-5350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6652 GLEN MEADOW LOOP",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338105881",
"telephone_number": "863-255-7300",
"fax_number": "863-859-5350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSELLE",
"first_name": "MARIANNE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-21",
"last_updated": "2025-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "593286346",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "67-7735000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.