Healthcare Provider Details

I. General information

NPI: 1063964658
Provider Name (Legal Business Name): PAMELA FAZEKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10404 W COGGINS DR STE 110
SUN CITY AZ
85351-3465
US

IV. Provider business mailing address

3201 W FEATHER SOUND DR
ANTHEM AZ
85086-1007
US

V. Phone/Fax

Practice location:
  • Phone: 715-495-0404
  • Fax:
Mailing address:
  • Phone: 623-399-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: