Healthcare Provider Details

I. General information

NPI: 1457804932
Provider Name (Legal Business Name): CHRISTAL GARZA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HOPE DRIVE
BAGDAD AZ
86321
US

IV. Provider business mailing address

PO BOX 1292
BAGDAD AZ
86321-1292
US

V. Phone/Fax

Practice location:
  • Phone: 928-633-6011
  • Fax:
Mailing address:
  • Phone: 928-633-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06161672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: