Provider Demographics
NPI:1033553854
Name:MICKLOS, LEILA (MS FNP-BC)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:MICKLOS
Suffix:
Gender:F
Credentials:MS FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4480
Mailing Address - Country:US
Mailing Address - Phone:480-661-4761
Mailing Address - Fax:480-661-3990
Practice Address - Street 1:8415 N. PIMA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4509
Practice Address - Country:US
Practice Address - Phone:480-661-4761
Practice Address - Fax:480-661-3990
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily