MEDICARE: DR. OCTAVIA TERESE GARCIA FNP

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	247943	AZ

General Provider Information

NPI Number	:	1457967812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OCTAVIA TERESE GARCIA FNP

Provider Business Mailing Address
First Line	:	7113 W SOPHIE LN
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-3475
Country	:	US
Telephone Number	:	619-600-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	8022 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6302
Country	:	US
Telephone Number	:	602-513-3616
Fax Number	:

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	10/28/2020

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