Healthcare Provider Details

I. General information

NPI: 1053117614
Provider Name (Legal Business Name): JASKIRAN KAUR DHALIWAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E CAMELBACK RD STE 126
PHOENIX AZ
85018-2322
US

IV. Provider business mailing address

3333 E CAMELBACK RD STE 126
PHOENIX AZ
85018-2322
US

V. Phone/Fax

Practice location:
  • Phone: 253-391-3434
  • Fax:
Mailing address:
  • Phone: 602-813-1468
  • Fax: 480-306-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number308737
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number308737
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: