Provider Demographics
NPI:1770281016
Name:MOORING, QUANZA ELISE (PHD, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:QUANZA
Middle Name:ELISE
Last Name:MOORING
Suffix:
Gender:
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746079
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6079
Mailing Address - Country:US
Mailing Address - Phone:281-707-7362
Mailing Address - Fax:
Practice Address - Street 1:11260 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3320
Practice Address - Country:US
Practice Address - Phone:313-749-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN04273363LF0000X
NC5020824363LF0000X
TN36864363LF0000X
VA0024190959363LF0000X
KY4025055363LF0000X
NJ26NJ15134500363LF0000X
TX1110862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily