Provider Demographics
NPI:1912151382
Name:MOORE, AMY L (MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 BOB WHITE PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2500
Mailing Address - Country:US
Mailing Address - Phone:408-655-6149
Mailing Address - Fax:
Practice Address - Street 1:20730 VALLEY GREEN DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1704
Practice Address - Country:US
Practice Address - Phone:408-783-4000
Practice Address - Fax:408-217-6140
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 681207163W00000X
CA681207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse