Healthcare Provider Details

I. General information

NPI: 1407253248
Provider Name (Legal Business Name): ASHLEIGH MARIE GAGE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

IV. Provider business mailing address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-4040
  • Fax: 480-830-1042
Mailing address:
  • Phone: 480-969-4040
  • Fax: 480-295-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8832
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN170753
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: