Provider Demographics
NPI:1376606483
Name:WINGATE, DEANA CACCAMO (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:CACCAMO
Last Name:WINGATE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:JO
Other - Last Name:CACCAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1621 W DEL RIO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6965
Mailing Address - Country:US
Mailing Address - Phone:480-899-4232
Mailing Address - Fax:480-899-5654
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:602-826-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN056258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily