Ethan Moss

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11034243 Issued in FL

Practice address

210 N Highway 27 Ste 4
Clermont, FL 34711-2411

Phone

(352) 988-6673

NPI assigned

Aug 20, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Life Counseling CenterGroup PAC ID 0648623835, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Family Life Counseling Center

  • Mental Health Counselor
  • Clermont, FL
  • NPI 1033665260
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1972336683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N HIGHWAY 27 STE 4",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N HIGHWAY 27 STE 4",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112411",
            "telephone_number": "352-988-6673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1965 S Orange Blossom Trl",
            "address_purpose": "LOCATION",
            "city": "Apopka",
            "state": "FL",
            "postal_code": "327037757",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "fax_number": "352-363-2496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Kentucky Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338015096",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "fax_number": "352-363-2496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9100 Conroy Windermere Rd",
            "address_purpose": "LOCATION",
            "city": "Windermere",
            "state": "FL",
            "postal_code": "347868431",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "fax_number": "352-363-2496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "858 S Duncan Dr",
            "address_purpose": "LOCATION",
            "city": "Tavares",
            "state": "FL",
            "postal_code": "327784044",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "fax_number": "352-363-2496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSS",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11034243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jose Antonio Moreno, M.D.
• Sara Michele Morillo, PA-C
• Kevin Frederick Moring, LPN
• Susan B Mortimer, LPN
• Elnora Moses
• Krystie Moss
• Amba Devi Motilal, APRN
• Ms Consulting & Support Services LLC
• Ruba Hamdan Mubarak
• Jean-Pierre B. Muhumuza, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Clermont, FL
• Providers in Clermont, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.