Healthcare Provider Details

I. General information

NPI: 1902779978
Provider Name (Legal Business Name): ANZHELIKA UVAYDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 100
GLENDALE AZ
85308-5665
US

IV. Provider business mailing address

1336 E VILLA THERESA DR
PHOENIX AZ
85022-1286
US

V. Phone/Fax

Practice location:
  • Phone: 602-848-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN329986
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: