MEDICARE: DR. HAYLEY AVINO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	261688	AZ

General Provider Information

NPI Number	:	1003589417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYLEY AVINO NP

Provider Business Mailing Address
First Line	:	3601 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6023
Country	:	US
Telephone Number	:	602-833-7714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	03/20/2024

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