Healthcare Provider Details

I. General information

NPI: 1518687029
Provider Name (Legal Business Name): PRIYANKA PATEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 N 28TH DR STE 205
PHOENIX AZ
85029-5635
US

IV. Provider business mailing address

11022 N 28TH DR STE 205
PHOENIX AZ
85029-5635
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-0304
  • Fax:
Mailing address:
  • Phone: 602-971-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN295828
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337455
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: