Healthcare Provider Details

I. General information

NPI: 1043476740
Provider Name (Legal Business Name): PHILIP MICHAEL GALLINARO APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date: 06/11/2024
Reactivation Date: 06/28/2024

III. Provider practice location address

8572 W PURDUE AVE
PEORIA AZ
85345-5349
US

IV. Provider business mailing address

9183 W FLAMINGO RD STE 100
LAS VEGAS NV
89147-6464
US

V. Phone/Fax

Practice location:
  • Phone: 602-653-7816
  • Fax:
Mailing address:
  • Phone: 602-653-7816
  • Fax: 702-975-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number868097
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: