Healthcare Provider Details

I. General information

NPI: 1437576642
Provider Name (Legal Business Name): BARBARA ANTOL-DLUGOPOLSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 N JUNIPER DR STE 200
CHANDLER AZ
85226-2559
US

IV. Provider business mailing address

585 N JUNIPER DR STE 200
CHANDLER AZ
85226-2559
US

V. Phone/Fax

Practice location:
  • Phone: 480-499-8700
  • Fax:
Mailing address:
  • Phone: 480-499-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8985
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: