MEDICARE: HAVEEN SAMED QARINI RN, BSN, FNP-C

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	222259	AZ

General Provider Information

NPI Number	:	1144931379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAVEEN SAMED QARINI RN, BSN, FNP-C

Provider Business Mailing Address
First Line	:	29762 N 69TH LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-3188
Country	:	US
Telephone Number	:	913-216-7503
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W UNION HILLS DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2429
Country	:	US
Telephone Number	:	623-328-8630
Fax Number	:

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

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	04/18/2023

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