Provider Demographics
NPI:1497793137
Name:COLORAFI, MARY JO (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:COLORAFI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:COLORAFI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2510 W DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2737
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-870-7566
Practice Address - Street 1:20401 N 73RD ST STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4146
Practice Address - Country:US
Practice Address - Phone:480-505-3484
Practice Address - Fax:480-505-3348
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN048547207Q00000X, 363L00000X
AZAP1544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ261959Medicaid
AZ1497793137OtherMEDICARE UPIN P83976
AZ834574Medicaid
AZ834574Medicaid
P83976Medicare UPIN
AZMC0830693OtherDEA
AZ834574Medicaid