Provider Demographics
NPI:1669074779
Name:PATEL, PRIYANKA D (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:DNP, 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:PO BOX 18810
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4083
Mailing Address - Country:US
Mailing Address - Phone:480-272-8877
Mailing Address - Fax:480-272-8998
Practice Address - Street 1:637 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8791
Practice Address - Country:US
Practice Address - Phone:480-272-8877
Practice Address - Fax:480-272-8998
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245677OtherLICENSE
AZMP6187454OtherDEA