Provider Demographics
NPI:1457673915
Name:ARNOLD, GINA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:THEROUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5155 E. EAGLE DRIVE #20730
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:480-378-2273
Practice Address - Street 1:4320 E. PRESIDIO STREET #101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-3031
Practice Address - Country:US
Practice Address - Phone:480-706-9430
Practice Address - Fax:480-378-2273
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ982948Medicaid
AZ982948Medicaid