Healthcare Provider Details

I. General information

NPI: 1639623531
Provider Name (Legal Business Name): CONSUELO MOORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONSUELO ROMERO

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 N ORACLE RD
TUCSON AZ
85705-3227
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 520-200-6707
  • Fax:
Mailing address:
  • Phone: 773-352-1517
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8755
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: