MEDICARE: TONIA LANETTE GRAHAM 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	363LP2300X	Primary Care Nurse Practitioner	AP5186	AZ
2	163W00000X	Registered Nurse	RN088868	AZ
3	363LF0000X	Family Nurse Practitioner	AP5186	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699108621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA LANETTE GRAHAM FNP

Provider Business Mailing Address
First Line	:	20449 N LAKE PLEASANT RD STE 101
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20449 N LAKE PLEASANT RD STE 101
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382
Country	:	US
Telephone Number	:	602-570-5587
Fax Number	:

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

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	01/21/2026

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