Provider Demographics
NPI:1851393433
Name:SARGENT, THERESE J (ANP-BC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:J
Last Name:SARGENT
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:J
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ANP
Mailing Address - Street 1:PO BOX 98819
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8819
Mailing Address - Country:US
Mailing Address - Phone:602-867-8644
Mailing Address - Fax:602-795-5698
Practice Address - Street 1:9250 N 3RD ST STE 2030
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2407
Practice Address - Country:US
Practice Address - Phone:602-786-0020
Practice Address - Fax:480-882-5870
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1054363L00000X
AZ109065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642034Medicaid
Z155118Medicare PIN
AZ500027546Medicare PIN
AZZ68570Medicare PIN
AZP58801Medicare UPIN
P58801Medicare UPIN
AZ642034Medicaid
AZZ131510Medicare PIN