MEDICARE: MRS. TEQUIA F PARKER

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	363L00000X	Nurse Practitioner	308374	AZ
2	363LF0000X	Family Nurse Practitioner	308374	AZ

General Provider Information

NPI Number	:	1912748039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEQUIA F PARKER

Provider Business Mailing Address
First Line	:	PO BOX 746093
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6093
Country	:	US
Telephone Number	:	888-702-0617
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 W MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-3862
Country	:	US
Telephone Number	:	602-671-7068
Fax Number	:	602-671-6946

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	09/09/2024

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Directions to “ MRS. TEQUIA F PARKER ” Practice Location

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