Provider Demographics
NPI:1194226928
Name:BOROS, ADINA RAMONA (DNP)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:RAMONA
Last Name:BOROS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1471
Mailing Address - Country:US
Mailing Address - Phone:602-258-1112
Mailing Address - Fax:480-401-0811
Practice Address - Street 1:5625 W BELL RD # 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3878
Practice Address - Country:US
Practice Address - Phone:602-239-4100
Practice Address - Fax:602-239-4040
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN178305363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017011250OtherBOARD CERTIFICATION