Provider Demographics
NPI:1013756808
Name:GALLOWAY, TARYLL (FNP-C)
Entity type:Individual
Prefix:
First Name:TARYLL
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:M
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 1:18828 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6345
Mailing Address - Country:US
Mailing Address - Phone:602-884-4080
Mailing Address - Fax:
Practice Address - Street 1:3415 W GLENDALE AVE STE 32A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8485
Practice Address - Country:US
Practice Address - Phone:602-246-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ307626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty