MEDICARE: MILDRED GARCIA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN553834	PA
2	363LP2300X	Primary Care Nurse Practitioner	247155	AZ
3	363LF0000X	Family Nurse Practitioner	247155	AZ

General Provider Information

NPI Number	:	1619257805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED GARCIA NP

Provider Business Mailing Address
First Line	:	6425 W MIAMI ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1937
Country	:	US
Telephone Number	:	623-387-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	6425 W MIAMI ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1937
Country	:	US
Telephone Number	:	717-330-2451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	03/01/2023

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