Provider Demographics
NPI:1174609606
Name:MORAN, BETH M (ARNP)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:3204 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6513
Mailing Address - Country:US
Mailing Address - Phone:941-925-7872
Mailing Address - Fax:631-919-1677
Practice Address - Street 1:11 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-3820
Practice Address - Country:US
Practice Address - Phone:941-925-7872
Practice Address - Fax:631-919-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3228682364SW0102X
NYF420030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4144Medicare PIN
NY90V271Medicare PIN
NYS44477Medicare UPIN