Provider Demographics
NPI:1578126611
Name:ENCINIAS, ANGEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ENCINIAS
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 1:10040 W JASMINE TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3370
Mailing Address - Country:US
Mailing Address - Phone:602-481-2599
Mailing Address - Fax:
Practice Address - Street 1:6702 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4402
Practice Address - Country:US
Practice Address - Phone:234-656-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily