Provider Demographics
NPI:1134122559
Name:MOFFA, CAROLYN M (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:MOFFA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4755 OGLETOWN STANTON ROAD SUITE 1E50
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718
Mailing Address - Country:US
Mailing Address - Phone:302-733-1507
Mailing Address - Fax:302-733-4998
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:STE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-366-8600
Practice Address - Fax:302-366-5646
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001118042Medicaid
DE140323ZA7AMedicare PIN
DE007714D12Medicare ID - Type Unspecified
DE0001118042Medicaid