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NPI Code Detail

MEDICARE: MRS. NICOLE LYNN MOORE CRNP

MEDICARE: MRS. NICOLE LYNN MOORE CRNP
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
1363LF0000XFamily Nurse PractitionerR179324MD
2363LF0000XFamily Nurse Practitioner0993089CO
3363LF0000XFamily Nurse PractitionerAPRN11009416FL

General Provider Information

NPI Number : 1780021436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE LYNN MOORE CRNP
Provider Business Mailing Address
First Line : 1512 TURTLE BAY CV
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-6506
Country : US
Telephone Number : 720-707-9033
Fax Number :
Provider Business Practice Location Address
First Line : 4475 SAN JUAN AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-3357
Country : US
Telephone Number : 615-425-4258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2013
Last Update Date : 02/09/2024

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