Provider Demographics
NPI:1427589191
Name:MOORE, AMBERLEE (ARNP)
Entity type:Individual
Prefix:
First Name:AMBERLEE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-873-2000
Mailing Address - Fax:757-873-2003
Practice Address - Street 1:704 THIMBLE SHOALS BLVD STE 700
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-873-2000
Practice Address - Fax:757-873-2003
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9292706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ350021Medicaid