Provider Demographics
NPI:1265761399
Name:CAVALLARO-MORETTI, TANYA CLESIE (DNP FNP-BC)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:CLESIE
Last Name:CAVALLARO-MORETTI
Suffix:
Gender:F
Credentials:DNP FNP-BC
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:CLESIE
Other - Last Name:CAVALLARO MORETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1717 E MORTEN AVE UNIT 34
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4756
Mailing Address - Country:US
Mailing Address - Phone:480-286-2866
Mailing Address - Fax:
Practice Address - Street 1:1717 E MORTEN AVE UNIT 34
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4756
Practice Address - Country:US
Practice Address - Phone:480-286-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-20
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily