Healthcare Provider Details

I. General information

NPI: 1518582477
Provider Name (Legal Business Name): PATRICIA HULTGREN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 S 40TH ST STE 100
PHOENIX AZ
85048-0563
US

IV. Provider business mailing address

745 W FLINTLOCK WAY
CHANDLER AZ
85286-6478
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6366
  • Fax:
Mailing address:
  • Phone: 402-208-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: