Provider Demographics
NPI:1457967812
Name:GARCIA, OCTAVIA TERESE (FNP)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIA
Middle Name:TERESE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 W SOPHIE LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3475
Mailing Address - Country:US
Mailing Address - Phone:619-600-9353
Mailing Address - Fax:
Practice Address - Street 1:8022 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6302
Practice Address - Country:US
Practice Address - Phone:602-513-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily