Provider Demographics
NPI:1851731053
Name:MOORE, JENNIFER ANNE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3805 E BELL ROAD SUITE #5300
Mailing Address - Street 2:#5300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-246-0351
Mailing Address - Fax:602-246-7023
Practice Address - Street 1:3805 E BELL RD STE 5600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2190
Practice Address - Country:US
Practice Address - Phone:833-696-3349
Practice Address - Fax:602-246-7023
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily