Healthcare Provider Details

I. General information

NPI: 1699108621
Provider Name (Legal Business Name): TONIA LANETTE GRAHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20449 N LAKE PLEASANT RD STE 101
PEORIA AZ
85382-2707
US

IV. Provider business mailing address

20449 N LAKE PLEASANT RD STE 101
PEORIA AZ
85382-2707
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-0099
  • Fax: 623-322-0966
Mailing address:
  • Phone: 623-322-0099
  • Fax: 623-322-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5186
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN088868
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP5186
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: