Provider Demographics
NPI:1821400755
Name:POWRZANAS, TREY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:
Last Name:POWRZANAS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W MINNEZONA AVENUE
Mailing Address - Street 2:UNIT 1125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:480-455-8355
Mailing Address - Fax:480-607-5119
Practice Address - Street 1:4350 N 19TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4602
Practice Address - Country:US
Practice Address - Phone:602-264-9191
Practice Address - Fax:602-532-2973
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5488363LP2300X
FLARNP9327523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care