MEDICARE: CHRISTINE MOORE ARNP

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	363L00000X	Nurse Practitioner	9362525	FL

General Provider Information

NPI Number	:	1780161851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MOORE ARNP

Provider Business Mailing Address
First Line	:	6 SEPTEMBER PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-4412
Country	:	US
Telephone Number	:	386-986-8514
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HEALTH PARK BLVD STE 5010
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-823-8809
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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