Provider Demographics
NPI:1578670121
Name:GARCIA, CONNIE ANN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:ANN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 W CORDIA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7404
Mailing Address - Country:US
Mailing Address - Phone:623-824-3660
Mailing Address - Fax:623-572-9405
Practice Address - Street 1:6610 W CORDIA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-7404
Practice Address - Country:US
Practice Address - Phone:623-824-3660
Practice Address - Fax:623-572-9405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN092190163WW0101X
AZ232367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ497835Medicaid
AZZ122159Medicare PIN