Healthcare Provider Details

I. General information

NPI: 1366890048
Provider Name (Legal Business Name): TAJMA FLAVIA PALMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 S 20TH AVE
SAFFORD AZ
85546-4011
US

IV. Provider business mailing address

1680 S 20TH AVE
SAFFORD AZ
85546-4011
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-1377
  • Fax: 928-428-6903
Mailing address:
  • Phone: 928-428-1377
  • Fax: 928-428-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP8712
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8712
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: