Healthcare Provider Details

I. General information

NPI: 1659950715
Provider Name (Legal Business Name): ANNA AMINOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 4100
PHOENIX AZ
85032-2167
US

IV. Provider business mailing address

3815 E BELL RD STE 2200
PHOENIX AZ
85032-2139
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5040
  • Fax: 602-494-4020
Mailing address:
  • Phone: 602-633-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: