Provider Demographics
NPI:1427426386
Name:MOORE, HEATHER GRACE (FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:GRACE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:GRACE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7525 METROPOLITAN DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4411
Mailing Address - Country:US
Mailing Address - Phone:619-325-1161
Mailing Address - Fax:619-325-1717
Practice Address - Street 1:7525 METROPOLITAN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-325-1161
Practice Address - Fax:619-325-1717
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily