MEDICARE: GINA FELETAR PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95038633	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	330932	AZ

General Provider Information

NPI Number	:	1730059676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA FELETAR PMHNP-BC

Provider Business Mailing Address
First Line	:	16601 N 40TH ST STE 216
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	619-313-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST STE 216
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	619-313-3507
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	04/03/2026

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Directions to “ GINA FELETAR PMHNP-BC” Practice Location

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