Provider Demographics
NPI:1578096798
Name:ADVANCED CLINICAL PRACTITIONERS, LLC
Entity Type:Organization
Organization Name:ADVANCED CLINICAL PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZDEBSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:623-399-8606
Mailing Address - Street 1:9815 E CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4737
Mailing Address - Country:US
Mailing Address - Phone:623-399-8606
Mailing Address - Fax:623-399-9958
Practice Address - Street 1:20823 N CAVE CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4468
Practice Address - Country:US
Practice Address - Phone:623-399-8606
Practice Address - Fax:623-399-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103493364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN103493OtherLICENSE
AZRN103493OtherLICENSE