Individual
ANDREA DIANE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
425 E STATE ST, JACKSONVILLE, IL 62650-2125
(217) 408-1195
Mailing address
425 E STATE ST, JACKSONVILLE, IL 62650-2125
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021039559
IL
Other
Enumeration date
11/29/2021
Last updated
01/09/2026
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