Healthcare Provider Details

I. General information

NPI: 1619257805
Provider Name (Legal Business Name): MILDRED GARCIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 W MIAMI ST
PHOENIX AZ
85043-1937
US

IV. Provider business mailing address

6425 W MIAMI ST
PHOENIX AZ
85043-1937
US

V. Phone/Fax

Practice location:
  • Phone: 717-330-2451
  • Fax:
Mailing address:
  • Phone: 623-387-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN553834
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number247155
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247155
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: