Provider Demographics
NPI:1003417072
Name:MORENO, CARMEN (APRN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 GOLFVIEW RD APT 909
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3512
Mailing Address - Country:US
Mailing Address - Phone:561-360-0955
Mailing Address - Fax:
Practice Address - Street 1:336 GOLFVIEW RD APT 909
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3512
Practice Address - Country:US
Practice Address - Phone:561-360-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010028363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics