Healthcare Provider Details

I. General information

NPI: 1275180457
Provider Name (Legal Business Name): NICOLE M SAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 S PRIEST DR STE 102
TEMPE AZ
85284-1914
US

IV. Provider business mailing address

8675 S PRIEST DR STE 102
TEMPE AZ
85284-1914
US

V. Phone/Fax

Practice location:
  • Phone: 480-739-0007
  • Fax: 480-779-6289
Mailing address:
  • Phone: 480-739-0007
  • Fax: 480-779-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: