Provider Demographics
NPI:1275217952
Name:PALACIOS, GINA JUDITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:JUDITH
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 E FRIER DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-7633
Mailing Address - Country:US
Mailing Address - Phone:602-578-8834
Mailing Address - Fax:602-916-1655
Practice Address - Street 1:1814 E FRIER DR UNIT 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-7633
Practice Address - Country:US
Practice Address - Phone:602-578-8834
Practice Address - Fax:602-916-1655
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ293225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner