Healthcare Provider Details

I. General information

NPI: 1619974748
Provider Name (Legal Business Name): PATRICIA KAY PARK FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 SOUTH HIGLEY RD., SUITE 114 PMB726
GILBERT AZ
85297
US

IV. Provider business mailing address

3317 SOUTH HIGLEY RD. SUITE114 PMB726
GILBERT AZ
85297
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-6962
  • Fax:
Mailing address:
  • Phone: 480-839-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN095230
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: