Healthcare Provider Details

I. General information

NPI: 1386088649
Provider Name (Legal Business Name): CRAIG ANGELO WIGGINS F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 305
PHOENIX AZ
85037-3366
US

IV. Provider business mailing address

4801 E MCDOWELL RD STE 150
PHOENIX AZ
85008-7725
US

V. Phone/Fax

Practice location:
  • Phone: 623-478-8000
  • Fax: 623-478-8003
Mailing address:
  • Phone: 602-954-3919
  • Fax: 602-954-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4898
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAP4898
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: