Healthcare Provider Details

I. General information

NPI: 1225638828
Provider Name (Legal Business Name): PAULINA ALICIA ZAPATA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2020
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E COTTONWOOD LN STE B4
CASA GRANDE AZ
85122-2517
US

IV. Provider business mailing address

317 E COTTONWOOD LN STE B4
CASA GRANDE AZ
85122-2517
US

V. Phone/Fax

Practice location:
  • Phone: 928-975-4091
  • Fax: 520-616-2658
Mailing address:
  • Phone: 928-975-4091
  • Fax: 520-616-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number255310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: