Provider Demographics
NPI:1639977275
Name:CHAVEZ, ELIZABETH DIANE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:CHAVEZ
Suffix:
Gender:
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 1:37584 N GANTZEL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7547
Mailing Address - Country:US
Mailing Address - Phone:480-257-3157
Mailing Address - Fax:480-207-7602
Practice Address - Street 1:37584 N GANTZEL RD STE 105
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7547
Practice Address - Country:US
Practice Address - Phone:480-257-3157
Practice Address - Fax:480-207-7602
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily