Healthcare Provider Details

I. General information

NPI: 1154098010
Provider Name (Legal Business Name): GIA CHRISTINE CACCAVALE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 W STATLER BLVD BLDG 1
SURPRISE AZ
85374-5501
US

IV. Provider business mailing address

15800 N LITCHFIELD RD
SURPRISE AZ
85374-5514
US

V. Phone/Fax

Practice location:
  • Phone: 623-478-3300
  • Fax:
Mailing address:
  • Phone: 623-478-3100
  • Fax: 623-478-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309785
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN197408
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: