Healthcare Provider Details

I. General information

NPI: 1881987261
Provider Name (Legal Business Name): NIKOLINA V ELEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S 7TH AVE
PHOENIX AZ
85007-3913
US

IV. Provider business mailing address

2700 N CENTRAL AVE STE 1050
PHOENIX AZ
85004-1217
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6600
  • Fax: 602-344-6601
Mailing address:
  • Phone: 602-266-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN139674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: