Provider Demographics
NPI:1063237634
Name:MOORE, CRISTIN (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 KAMEHAMEHA V HWY
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-4061
Mailing Address - Country:US
Mailing Address - Phone:808-354-2154
Mailing Address - Fax:
Practice Address - Street 1:1551 KAMEHAMEHA V HWY
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-4061
Practice Address - Country:US
Practice Address - Phone:808-354-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily