Provider Demographics
NPI:1740733740
Name:MOORE, TENESIA NICOLE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TENESIA
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2044
Mailing Address - Country:US
Mailing Address - Phone:901-340-2397
Mailing Address - Fax:972-685-5108
Practice Address - Street 1:777 E WHEATLAND RD STE 106
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-685-5094
Practice Address - Fax:972-685-5108
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2024-03-04
Deactivation Date:2016-08-15
Deactivation Code:
Reactivation Date:2020-10-15
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000026365363L00000X
TN160948163WH0200X
TX1059858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome Health