Provider Demographics
NPI:1942811997
Name:ANDERSEN, RAQUIEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAQUIEL
Middle Name:
Last Name:ANDERSEN
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 1:126 S CORONADO DR STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6300
Mailing Address - Country:US
Mailing Address - Phone:204-390-1155
Mailing Address - Fax:520-458-3016
Practice Address - Street 1:126 S CORONADO DR STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6300
Practice Address - Country:US
Practice Address - Phone:808-738-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily