Healthcare Provider Details

I. General information

NPI: 1912151382
Provider Name (Legal Business Name): AMY L. MOORE MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20730 VALLEY GREEN DR
CUPERTINO CA
95014-1704
US

IV. Provider business mailing address

1441 BOB WHITE PL
SAN JOSE CA
95131-2500
US

V. Phone/Fax

Practice location:
  • Phone: 408-783-4000
  • Fax: 408-217-6140
Mailing address:
  • Phone: 408-655-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 681207
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number681207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: