Provider Demographics
NPI:1144403429
Name:ATHETIS, GINA LINN (FNP-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LINN
Last Name:ATHETIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4350 N 19TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4602
Mailing Address - Country:US
Mailing Address - Phone:480-607-1124
Mailing Address - Fax:480-607-1087
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:SUITE A300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1204
Practice Address - Country:US
Practice Address - Phone:480-607-1124
Practice Address - Fax:480-607-1087
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2010-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN077817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126965Medicare Oscar/Certification