Provider Demographics
NPI:1346260320
Name:MORENO, JANEL SHARP (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:SHARP
Last Name:MORENO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:JANEL
Other - Middle Name:JAYME
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:ATTN: 21 MDDS/SGOF - FAM HLTH
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:719-526-2273
Mailing Address - Fax:877-813-1756
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:ATTN: 21 MDDS/SGOF - FAM HLTH
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-526-2273
Practice Address - Fax:877-813-1756
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0991000363LF0000X
VA0024177882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306367400Medicaid
FLQ00164Medicare UPIN
FLU1610ZMedicare ID - Type Unspecified