MEDICARE: MR. CRAIG ANGELO WIGGINS F.N.P.

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	207N00000X	Dermatology Physician	AP4898	AZ
2	363LF0000X	Family Nurse Practitioner	AP4898	AZ

General Provider Information

NPI Number	:	1386088649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG ANGELO WIGGINS F.N.P.

Provider Business Mailing Address
First Line	:	4801 E MCDOWELL RD STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7725
Country	:	US
Telephone Number	:	602-954-3919
Fax Number	:	602-954-3670

Provider Business Practice Location Address
First Line	:	9305 W THOMAS RD STE 305
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3366
Country	:	US
Telephone Number	:	623-478-8000
Fax Number	:	623-478-8003

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	12/08/2023

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