Healthcare Provider Details

I. General information

NPI: 1376336545
Provider Name (Legal Business Name): RACHEL FLYNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20255 N LAKE PLEASANT RD STE 102
PEORIA AZ
85382-9747
US

IV. Provider business mailing address

20255 N LAKE PLEASANT RD
PEORIA AZ
85382-9747
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-8225
  • Fax:
Mailing address:
  • Phone: 623-376-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228710
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: