Mandy Lynn Moore, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP9207746 Issued in FL

Practice address

1920 Don Wickham Drive
Suit 330
Clermont, FL 34711

Phone

(352) 241-4298

Fax

(352) 241-7620

NPI assigned

Jan 30, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mandy Lynn Woodruff Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Florida College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leavitt Medical Associates of Florida IncGroup PAC ID 4688579311, 199 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surq

  • Dermatology Physician
  • Sebastian, FL
  • NPI 1083872535
  Medicare reassignment Care Compare group NPD
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surgery

  • Dermatology Physician
  • Clermont, FL
  • NPI 1144488628
  NPD
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology And Cosmetic Surgery

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1396168118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LANE",
            "address_2": "SUITE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 DON WICKHAM DRIVE",
            "address_2": "SUIT 330",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "34711",
            "telephone_number": "352-241-4298",
            "fax_number": "352-241-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MANDY",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-30",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9207746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012103300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "WOODRUFF",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Covyn Montemayor, AP, DIPL. OM
• Natalia Montenegro, MSN, FNP-BC
• Kristen Montney
• Leah Song Moon, FNP
• Julius David Moore Jr., M.D.
• Ramona Mootoo, BCBA
• Camille Suzette Morales Zambrana, PA-C
• Jalisa Morales
• Maria Alejandra Moreno Cabasos, NP
• Jose Antonio Moreno, M.D.

• Nurse Practitioner in Clermont, FL
• Providers in Clermont, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.