Healthcare Provider Details

I. General information

NPI: 1679235808
Provider Name (Legal Business Name): GEOFF ROSS IBE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16772 W BELL RD STE 110-619
SURPRISE AZ
85374-9702
US

IV. Provider business mailing address

16772 W BELL RD STE 110-619
SURPRISE AZ
85374-9702
US

V. Phone/Fax

Practice location:
  • Phone: 602-844-4855
  • Fax: 480-900-8478
Mailing address:
  • Phone: 602-844-4855
  • Fax: 480-900-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number265209
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number265209
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number265209
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: