Provider Demographics
NPI:1417226267
Name:PEREZ, GLORIA ADRIANA (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ADRIANA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ADRIANA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, ANP-BC
Mailing Address - Street 1:864 E. DEVON RD.
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:ARIZONA
Mailing Address - Zip Code:85296
Mailing Address - Country:UM
Mailing Address - Phone:602-410-5905
Mailing Address - Fax:
Practice Address - Street 1:500 N 3RD ST
Practice Address - Street 2:ARIZONA STATE UNIVERSITY COLLEGE OF NURSING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2135
Practice Address - Country:US
Practice Address - Phone:602-496-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4381363LA2200X
AZRN106985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse