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General NPI Number Information
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NPI Number | 1669376265
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Entity Type | Individual
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Provider Name | DESIRE ALEXIS COLLISTER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1863 E FLORENCE BLVD
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City | CASA GRANDE
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State | AZ
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Zip | 85122
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Country | US
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Telephone | 520-836-3446
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S SAN JOSE LN
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City | CASA GRANDE
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State | AZ
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Zip | 85194-7413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 260568
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License Number State | AZ
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