Provider Demographics
NPI:1821738170
Name:HERRERA, JUAN RAMON (APRN PMHNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:RAMON
Last Name:HERRERA
Suffix:
Gender:M
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 N 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5658
Mailing Address - Country:US
Mailing Address - Phone:623-583-0232
Mailing Address - Fax:
Practice Address - Street 1:14100 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5658
Practice Address - Country:US
Practice Address - Phone:623-523-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274083363LP0808X
AZ2021185337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health