MEDICARE: MISS ANTOINETTE GRACE FLORES 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	363LP2300X	Primary Care Nurse Practitioner	261176	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	261176	AZ

General Provider Information

NPI Number	:	1669140299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANTOINETTE GRACE FLORES NP

Provider Business Mailing Address
First Line	:	13755 N LITCHFIELD RD STE 105
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-4288
Country	:	US
Telephone Number	:	623-322-5900
Fax Number	:	623-249-4344

Provider Business Practice Location Address
First Line	:	1860 N 95TH LN STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5074
Country	:	US
Telephone Number	:	806-267-5844
Fax Number	:	480-210-0230

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	01/24/2024

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