MEDICARE: ENA SALAK 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	223011	AZ

General Provider Information

NPI Number	:	1861336687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENA SALAK FNP

Provider Business Mailing Address
First Line	:	1121 N 44TH ST APT 3098
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-5743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5161
Country	:	US
Telephone Number	:	602-845-4505
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ ENA SALAK FNP” Practice Location

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