Provider Demographics
NPI:1821888538
Name:FITZGIBBONS, MOLLY (FNP-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:FITZGIBBONS
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 1:4212 E ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6772
Mailing Address - Country:US
Mailing Address - Phone:520-840-6149
Mailing Address - Fax:
Practice Address - Street 1:4212 E ROCKLEDGE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6772
Practice Address - Country:US
Practice Address - Phone:520-840-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ314600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily