Provider Demographics
NPI:1972119535
Name:SERFINO, DENNIS CARMELO CADIZ (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:DENNIS CARMELO
Middle Name:CADIZ
Last Name:SERFINO
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 W SADDLEHORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-3429
Mailing Address - Country:US
Mailing Address - Phone:623-698-8644
Mailing Address - Fax:
Practice Address - Street 1:5333 N 7TH ST STE B305
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2803
Practice Address - Country:US
Practice Address - Phone:623-698-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009005363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health