Active NPI
Deandrea Moore
- Home Health Aide
- Titusville, FL
National Provider Identifier
1730788662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 379 Macon Dr
Titusville, FL 32780-9106 - Phone
- (321) 890-9737
- NPI assigned
- Oct 21, 2020
- Last updated
- Oct 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 95533 | FL | |
| Home Health Aide | 374U00000X | NU | Primary |
Addresses
Primary practice location
379 Macon Dr
Titusville, FL 32780-9106
Mailing address
379 Macon Dr
Titusville, FL 32780-9106
Phone (321) 890-9737
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 833025863 | 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 |
|---|---|---|---|
| 95533 | FL | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603238400000",
"number": "1730788662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "379 MACON DR",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327809106",
"telephone_number": "321-890-9737",
"fax_number": "321-567-2164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "379 MACON DR",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327809106",
"telephone_number": "321-890-9737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DEANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-21",
"last_updated": "2020-10-21",
"certification_date": "2020-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "FL",
"license": "95533",
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "833025863",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.