MEDICARE: CAROLINE T. MOORE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	APRN.CNP.003806	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.003806	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366275448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE T. MOORE FNP

Provider Business Mailing Address
First Line	:	1000 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1333
Country	:	US
Telephone Number	:	614-252-3636
Fax Number	:	614-251-4061

Provider Business Practice Location Address
First Line	:	1000 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1333
Country	:	US
Telephone Number	:	614-252-3636
Fax Number	:	614-251-4061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	04/16/2025

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