Provider Demographics
NPI:1407535636
Name:MOORE, ANDREW THOMAS (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:MOORE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:592 S HIGHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4514
Mailing Address - Country:US
Mailing Address - Phone:801-837-2791
Mailing Address - Fax:
Practice Address - Street 1:592 S HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-4514
Practice Address - Country:US
Practice Address - Phone:801-837-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9783190-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse