Provider Demographics
NPI:1821549106
Name:MORENO, VIVIAN YVETTE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:YVETTE
Last Name:MORENO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245024
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-7556
Mailing Address - Fax:520-626-7077
Practice Address - Street 1:3838 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1478
Practice Address - Country:US
Practice Address - Phone:520-694-2873
Practice Address - Fax:520-694-0848
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily