Provider Demographics
NPI:1780224105
Name:MENDEZ, ELENA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MENDEZ
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 1:1644 W THUNDERHILL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-1801
Mailing Address - Country:US
Mailing Address - Phone:602-410-7145
Mailing Address - Fax:
Practice Address - Street 1:5656 E ORANGE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8139
Practice Address - Country:US
Practice Address - Phone:602-601-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily