Healthcare Provider Details

I. General information

NPI: 1093058950
Provider Name (Legal Business Name): ANTO N VUKANCIC FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 N 75TH AVE
PHOENIX AZ
85035-1216
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-3264
  • Fax: 623-849-7785
Mailing address:
  • Phone: 623-277-1130
  • Fax: 866-837-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: