Provider Demographics
NPI:1578007480
Name:HOADLEY, ROBERT (FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HOADLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 N 19TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4602
Mailing Address - Country:US
Mailing Address - Phone:602-264-9191
Mailing Address - Fax:602-532-2956
Practice Address - Street 1:4350 N 19TH AVE
Practice Address - Street 2:SUIT 6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4602
Practice Address - Country:US
Practice Address - Phone:602-264-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN179081163W00000X
NJ26NR20877300363LF0000X
COC-APN.0001282-C-NP363LF0000X
WAAP60908558363LF0000X
AZAP9881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ283651Medicaid
CO9000167955Medicaid
WA2121117Medicaid