Provider Demographics
NPI:1629302229
Name:IGLESIAS, DEBRA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1277
Mailing Address - Country:US
Mailing Address - Phone:602-243-7277
Mailing Address - Fax:602-323-8048
Practice Address - Street 1:140 N LITCHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1277
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-323-8048
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ483825Medicaid
AZZ135071Medicare PIN
AZ483825Medicaid