Healthcare Provider Details

I. General information

NPI: 1194492306
Provider Name (Legal Business Name): DEBORAH A GOROMBEI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 03/07/2023
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 143
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

4939 W RAY RD # 4-118
CHANDLER AZ
85226-2065
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-1305
  • Fax:
Mailing address:
  • Phone: 602-550-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262885
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTEMP262885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: