Healthcare Provider Details

I. General information

NPI: 1669140299
Provider Name (Legal Business Name): ANTOINETTE GRACE FLORES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N 95TH LN STE 300
PHOENIX AZ
85037-5074
US

IV. Provider business mailing address

1860 N 95TH LN STE 300
PHOENIX AZ
85037-5074
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax: 480-210-0230
Mailing address:
  • Phone: 480-626-7584
  • Fax: 480-210-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number261176
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number261176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: