Healthcare Provider Details

I. General information

NPI: 1376363705
Provider Name (Legal Business Name): TERESA ANNA VON BORRIES VALENTI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 W THOMAS RD
PHOENIX AZ
85015-6101
US

IV. Provider business mailing address

1514 W THOMAS RD
PHOENIX AZ
85015-6101
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-5732
  • Fax:
Mailing address:
  • Phone: 602-283-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228392
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: