Healthcare Provider Details

I. General information

NPI: 1942059993
Provider Name (Legal Business Name): ELIZABETH GRIJALVA APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N F AVE
DOUGLAS AZ
85607-1919
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-3285
  • Fax: 520-364-3378
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-515-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230180
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: