Individual provider Active NPI

Jessica Kay Moe, CNM

  • Advanced Practice Midwife
  • Lakeland, FL
National Provider Identifier
1568063139
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
APRN11006081 Issued in FL
Practice address
1733 Lakeland Hills Blvd
Lakeland, FL 33805-3016
Phone
(863) 688-1528
Fax
(863) 688-8423
NPI assigned
Nov 2, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X APRN11006081 FL
Advanced Practice Midwife 367A00000X APRN11006081 FL Primary

Addresses

Primary practice location

1733 Lakeland Hills Blvd
Lakeland, FL 33805-3016

Mailing address

PO Box 748817
Atlanta, GA 30374-8817
Phone (813) 286-0033

Other practice location 1

2352 Bruce B Downs Blvd Ste 301
Wesley Chapel, FL 33544-9203
Phone (813) 991-7416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201111000143 FL Practitioner - Certified Nurse Midwife (CNM) 1850701442 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
APRN11006081FLMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Care Florida LLC Advanced Practice Midwife CurrentSince Nov 16, 2023 Accepting new patients
Womens' Health Hospitalists, LLC CurrentSince Oct 16, 2023 Accepting new patients
Vitalmd Group Holding LLC PastSince Feb 7, 2022 Accepting new patients

Locations

1733 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 688-1528

4030 W Boy Scout Blvd
Ste 800
Tampa, FL 33607
Phone (813) 286-0333

2818 W Virginia Ave
Tampa, FL 33607
Phone (813) 872-8551

5002 W Lemon St
Tampa, FL 33609

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1568063139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748817",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748817",
            "telephone_number": "813-286-0033",
            "fax_number": "813-282-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1733 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053016",
            "telephone_number": "863-688-1528",
            "fax_number": "863-688-8423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2352 Bruce B Downs Blvd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Wesley Chapel",
            "state": "FL",
            "postal_code": "335449203",
            "country_code": "US",
            "telephone_number": "813-991-7416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOE",
        "first_name": "JESSICA",
        "middle_name": "KAY",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "FL",
            "license": "APRN11006081",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "FL",
            "license": "APRN11006081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.