MEDICARE: CONSUELO MOORE FNP-C

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	363LF0000X	Family Nurse Practitioner	AP8755	AZ

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	:	1639623531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELO MOORE FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 746093
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6093
Country	:	US
Telephone Number	:	520-200-6707
Fax Number	:	520-300-8052

Provider Business Practice Location Address
First Line	:	3820 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3227
Country	:	US
Telephone Number	:	520-200-6707
Fax Number	:

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	03/12/2026

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