Provider Demographics
NPI:1922612084
Name:GRIJALVA, ANNA MARIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:GRIJALVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2340 E BEARDSLEY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1287
Mailing Address - Country:US
Mailing Address - Phone:602-802-8240
Mailing Address - Fax:602-802-8245
Practice Address - Street 1:2340 E BEARDSLEY RD STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1287
Practice Address - Country:US
Practice Address - Phone:602-802-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily