Healthcare Provider Details

I. General information

NPI: 1548235773
Provider Name (Legal Business Name): MICHAEL ANDREW HART FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 W PEORIA AVE
PEORIA AZ
85345-6108
US

IV. Provider business mailing address

5392 W TARO LN
GLENDALE AZ
85308-4964
US

V. Phone/Fax

Practice location:
  • Phone: 623-281-1620
  • Fax: 623-281-1622
Mailing address:
  • Phone: 623-262-1010
  • Fax: 623-242-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAP11665
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11665
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN109444
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN109444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: