Provider Demographics
NPI:1366275448
Name:MOORE, CAROLINE T (FNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:T
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:T
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1333
Mailing Address - Country:US
Mailing Address - Phone:614-252-3636
Mailing Address - Fax:614-251-4061
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1333
Practice Address - Country:US
Practice Address - Phone:614-252-3636
Practice Address - Fax:614-251-4061
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.003806207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071090Medicaid