Healthcare Provider Details

I. General information

NPI: 1588369003
Provider Name (Legal Business Name): TERESITA A LUNA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 146
GILBERT AZ
85295-1636
US

IV. Provider business mailing address

10445 E SHEFFIELD DR
MESA AZ
85212-9403
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-6766
  • Fax:
Mailing address:
  • Phone: 512-201-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number301422
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number301422
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: