Healthcare Provider Details

I. General information

NPI: 1497949499
Provider Name (Legal Business Name): JACQUELINE LIZARDO GUZMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 W MCDOWELL RD STE 5015
AVONDALE AZ
85392-4869
US

IV. Provider business mailing address

10320 W MCDOWELL RD STE 5015
AVONDALE AZ
85392-4869
US

V. Phone/Fax

Practice location:
  • Phone: 623-980-2150
  • Fax: 480-546-3821
Mailing address:
  • Phone: 469-500-2458
  • Fax: 480-546-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8941
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP8686
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: