Provider Demographics
NPI:1407598816
Name:BARAJAS, ERICA NICHOLS (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NICHOLS
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8584 N COX RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-7589
Mailing Address - Country:US
Mailing Address - Phone:520-233-0062
Mailing Address - Fax:
Practice Address - Street 1:8584 N COX RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-7589
Practice Address - Country:US
Practice Address - Phone:520-233-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ273531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty