Healthcare Provider Details

I. General information

NPI: 1205564903
Provider Name (Legal Business Name): NORMA ANGELICA AGUIRRE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 N 108TH AVE STE 120
PHOENIX AZ
85037-5773
US

IV. Provider business mailing address

6427 W ELLIS DR
LAVEEN AZ
85339-9771
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-4868
  • Fax:
Mailing address:
  • Phone: 602-403-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number278252
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: