Healthcare Provider Details

I. General information

NPI: 1679000533
Provider Name (Legal Business Name): ANGELA MARIE ACQUAFREDDA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MARIE TOVAR RN

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST STE 161
PHOENIX AZ
85044-9139
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 280
PHOENIX AZ
85012-1349
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-4493
  • Fax: 602-716-9656
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: