Healthcare Provider Details

I. General information

NPI: 1568397677
Provider Name (Legal Business Name): LINDA HIRONIMUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 900B
PHOENIX AZ
85013-4223
US

IV. Provider business mailing address

4102 E LAKESIDE BLVD
PHOENIX AZ
85044-3961
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8771
  • Fax:
Mailing address:
  • Phone: 480-862-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340709
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: