Healthcare Provider Details

I. General information

NPI: 1073943825
Provider Name (Legal Business Name): EVA SOCORRO MIJARES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E MC 85
BUCKEYE AZ
85326
US

IV. Provider business mailing address

1216 S 111TH DR UNIT 1087
CASHION AZ
85329-7074
US

V. Phone/Fax

Practice location:
  • Phone: 602-363-3438
  • Fax: 602-584-3677
Mailing address:
  • Phone: 602-399-3941
  • Fax: 602-584-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN128794
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: