Healthcare Provider Details

I. General information

NPI: 1316151780
Provider Name (Legal Business Name): MARIA A MEDEROS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 W MCDOWELL RD
PHOENIX AZ
85035-3862
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 602-671-7068
  • Fax: 602-671-6946
Mailing address:
  • Phone: 602-671-7068
  • Fax: 602-671-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number305475
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 2802932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: