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General NPI Number Information
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NPI Number | 1669389904
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Entity Type | Organization
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Legal Business Name | AGAVE ROOTS HEALTH CARE LLC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 29755 N VARNUM RD
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-7007
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Country | US
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Telephone | 480-760-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 29755 N VARNUM RD
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-7007
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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 | FNP
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Name | MR. RYAN TAYLOR
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Credential |
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Telephone | 480-760-5136
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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 |
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License Number State |
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