Healthcare Provider Details

I. General information

NPI: 1225653694
Provider Name (Legal Business Name): STEPHANIE FLORES RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 W FRYE RD STE 5
CHANDLER AZ
85224-6238
US

IV. Provider business mailing address

8340 E BASELINE RD APT 1007
MESA AZ
85209-5420
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-5900
  • Fax:
Mailing address:
  • Phone: 480-244-2509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number241840
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRNP241840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: