Provider Demographics
NPI:1568135242
Name:FLEMING, TALIA CAMILLE (FNP)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:CAMILLE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 E BELL RD # 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2727
Mailing Address - Country:US
Mailing Address - Phone:707-498-1635
Mailing Address - Fax:
Practice Address - Street 1:EMBRY HEALTH
Practice Address - Street 2:4717 E HILTON AVE SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034
Practice Address - Country:US
Practice Address - Phone:480-376-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06212176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty