Provider Demographics
NPI:1225842016
Name:MOSEY, NICOLE TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TAYLOR
Last Name:MOSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OUTER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6652
Mailing Address - Country:US
Mailing Address - Phone:407-895-8818
Mailing Address - Fax:
Practice Address - Street 1:440 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4206
Practice Address - Country:US
Practice Address - Phone:407-895-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant