Healthcare Provider Details

I. General information

NPI: 1952601908
Provider Name (Legal Business Name): FLOR MARLENE PHILLIPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 870
PHOENIX AZ
85013-4218
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1175
PHOENIX AZ
85012-0002
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax: 480-646-1002
Mailing address:
  • Phone: 888-698-6727
  • Fax: 602-564-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: