Healthcare Provider Details

I. General information

NPI: 1508211921
Provider Name (Legal Business Name): DANIEL COUCH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

IV. Provider business mailing address

825 W QUEEN CREEK RD APT 1021
CHANDLER AZ
85248-3208
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-9650
  • Fax: 480-834-3606
Mailing address:
  • Phone: 256-572-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number258294
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number258294
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: