Healthcare Provider Details

I. General information

NPI: 1508496167
Provider Name (Legal Business Name): CLAUDIA MACIAS AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 103
PHOENIX AZ
85006-2607
US

IV. Provider business mailing address

3810 NORTHDALE BLVD STE 150
TAMPA FL
33624-1871
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax: 888-812-8191
Mailing address:
  • Phone: 800-991-6117
  • Fax: 888-812-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRNP235607
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number235607
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: