Provider Demographics
NPI:1871546788
Name:MOISE-JOHNSON, DAPHNEE (MD)
Entity type:Individual
Prefix:DR
First Name:DAPHNEE
Middle Name:
Last Name:MOISE-JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:DAPHNEE
Other - Middle Name:
Other - Last Name:MOISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6214 MEMORIAL HWY STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4507
Mailing Address - Country:US
Mailing Address - Phone:800-574-9491
Mailing Address - Fax:800-547-2802
Practice Address - Street 1:2830 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7115
Practice Address - Country:US
Practice Address - Phone:941-927-1234
Practice Address - Fax:921-921-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93843208D00000X, 207P00000X, 261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH273932100Medicaid
OH273932100Medicaid