Provider Demographics
NPI:1184840712
Name:MOORE, ANN CHRISTINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:CHRISTINE
Last Name:MOORE
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 1:2201 W FAIRVIEW ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4711
Mailing Address - Country:US
Mailing Address - Phone:480-470-4000
Mailing Address - Fax:480-686-8875
Practice Address - Street 1:6677 THUNDERBIRD ROAD
Practice Address - Street 2:BUILDING G, #116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:480-686-8874
Practice Address - Fax:480-686-8875
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392956Medicaid
AZZ126973Medicare PIN
AZZ135935Medicare PIN
AZ392956Medicaid
AZZ135937Medicare PIN
AZZ152185Medicare PIN
Z146496Medicare PIN