Healthcare Provider Details

I. General information

NPI: 1619213469
Provider Name (Legal Business Name): AARON NICHOLS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 10/18/2022
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14961 W BELL RD #175
SURPRISE AZ
85374-6003
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 226
LITCHFIELD PARK AZ
85340-9426
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-9830
  • Fax:
Mailing address:
  • Phone: 623-233-1050
  • Fax: 623-248-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: