Provider Demographics
NPI:1467545335
Name:FRASCA, JACQUELINE ANNMARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNMARIE
Last Name:FRASCA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE C-142
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-247-1081
Mailing Address - Fax:623-247-2962
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:SUITE C-142
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-247-1081
Practice Address - Fax:623-247-2962
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ155391Medicaid
AZZ155269Medicare PIN