Provider Demographics
NPI:1306690144
Name:MORAN, CAROLINE (PNP-PC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MANORSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4738
Mailing Address - Country:US
Mailing Address - Phone:732-580-0916
Mailing Address - Fax:
Practice Address - Street 1:188 MANORSIDE DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4738
Practice Address - Country:US
Practice Address - Phone:732-580-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15046500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics