Provider Demographics
NPI:1578118808
Name:VALIQUETTE, CAROL ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:VALIQUETTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 W PEAK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6368
Mailing Address - Country:US
Mailing Address - Phone:541-951-1063
Mailing Address - Fax:
Practice Address - Street 1:15521 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3437
Practice Address - Country:US
Practice Address - Phone:541-951-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235104363LF0000X
AZRN187300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1578118088Medicaid