Lourdes A Mosley, PA
Individual provider Active NPI Medical Physician Assistant · Tallahassee, FL
NPI 1457547499 · NPPES record last updated Feb 14, 2017
Key facts
- NPI
- 1457547499
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA9100055
- Practice address
- 960 Learning Way
Tallahassee, FL 32306-4178 - Phone
- (850) 644-1802
- Fax
- (850) 644-4251
- NPI assigned
- Sep 24, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071203000565 | FL | Practitioner - Physician Assistant | 3779672449 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9100055 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guidewell Sanitas I, LLC | Current |
Accepting new patients | |
| North Florida Pediatrics, PA | Past | Accepting new patients |
Locations
8400 NW 33rd St
Ste 201
Doral, FL 33122
Phone (786) 882-2869
3617 W Hillsborough Ave
Tampa, FL 33614
Phone (813) 675-2020
Interoperability endpoints
- lourdes.mosley.p1@direct.nfpeds.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA9100055 | FL | |
| Medical Physician Assistant | 363AM0700X | PA9100055 | Yes |
Addresses
Primary practice location
960 Learning Way
Tallahassee, FL 32306-4178
Mailing address
960 Learning Way
Tallahassee, FL 32306-4178
Phone (850) 644-1802
Other providers in Tallahassee, FL
- James Edward Moses II
- Kennon Deon Moses
- Coleman James Mosher
- Kofi Mosley-Kellum
- Juan F Mosley II
- Vashawn Renee Mosley
- Faith Mostella-Morgan
- Manoela Mota
- Saint Claire Jacqueline Mottley
- Alan Moudy
All providers in Tallahassee, FL · Medical Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.