Provider Demographics
NPI:1235314089
Name:GARIBALDI, ANN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GARIBALDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-263-4722
Mailing Address - Fax:928-263-4794
Practice Address - Street 1:2226 HUALAPAI MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8374
Practice Address - Country:US
Practice Address - Phone:928-681-8530
Practice Address - Fax:928-681-8714
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1953363A00000X
AZ4249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant