Provider Demographics
NPI:1609644566
Name:GARCIA, LOUISSE MA SOCCORO (FNP)
Entity Type:Individual
Prefix:
First Name:LOUISSE MA SOCCORO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14518 W LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5690
Mailing Address - Country:US
Mailing Address - Phone:623-239-7681
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3047
Practice Address - Country:US
Practice Address - Phone:623-300-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily