Provider Demographics
NPI:1609431824
Name:SPANN, GARRETT CHRISTOPHER (FNP)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:CHRISTOPHER
Last Name:SPANN
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 1:3954 S WHITMAN CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2528
Mailing Address - Country:US
Mailing Address - Phone:480-416-0465
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 310
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2465
Practice Address - Country:US
Practice Address - Phone:480-351-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty