Individual provider Active NPI

Nicole M. Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Sunrise, FL
National Provider Identifier
1326019811
Registry record updated Jul 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP04643 Issued in LA
Practice address
1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853
Phone
(954) 838-2371
NPI assigned
Jan 31, 2006
Last updated
Jul 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP04643 LA Primary

Addresses

Primary practice location

1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853

Mailing address

PO Box 452015
Sunrise, FL 33345-2015

Other practice location 1

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2574

Other identifiers 1

IdentifierTypeStateIssuer
1612201MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050531000021 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880648427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Youngs Professional Services LLCGroup PAC ID 2163524992, 297 clinicians

Practice addresses (Care Compare)

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP04643LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2019 Accepting new patients
Medical Center Anesthesia Associates PA PastSince May 1, 2017 Accepting new patients
Medical Center Anesthesia Associates PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Texas Anesthesiology Consultants of Houston PA Past Accepting new patients
River Oaks Anesthesia Consultants PA Past Accepting new patients

Locations

4600 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 371-3135

4630 Ambassador Caffery Pkwy
Ste 101
Lafayette, LA 70508
Phone (337) 289-3324

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 470-2000

1100 Andre St
Ste 300
New Iberia, LA 70563
Phone (337) 364-9225

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1326019811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 452015",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333452015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 HARRISON PKWY",
            "address_2": "#200",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232853",
            "telephone_number": "954-838-2371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4801 Ambassador Caffery Pkwy",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705086917",
            "country_code": "US",
            "telephone_number": "337-470-2574",
            "fax_number": "337-470-2605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-31",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "AP04643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1612201",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.