Healthcare Provider Details

I. General information

NPI: 1144625799
Provider Name (Legal Business Name): SANDRA DEGROAT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA BOSHKO

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16165 N 83RD AVE
PEORIA AZ
85382-5816
US

IV. Provider business mailing address

16165 N 83RD AVE
PEORIA AZ
85382-5816
US

V. Phone/Fax

Practice location:
  • Phone: 480-974-6969
  • Fax:
Mailing address:
  • Phone: 480-974-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number296854
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70014461
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00528400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: