Healthcare Provider Details

I. General information

NPI: 1609487776
Provider Name (Legal Business Name): GINA AZEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 GREG ST
SPARKS NV
89431-5989
US

IV. Provider business mailing address

1430 GREG ST STE 503
SPARKS NV
89431-5900
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number832369
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: