Individual
CHAQUITA M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
160 SPRING BRANCH DR, DUBLIN, GA 31021-0356
(478) 274-8489
(478) 275-0731
Mailing address
205 FOX DEN CT, DUBLIN, GA 31021-4361
(478) 361-9621
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN138492 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN138492 NP
LICENSE
GA
Enumeration date
01/22/2007
Last updated
10/31/2017
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