Provider Demographics
NPI:1902304801
Name:HERRERA, PATRICIA ISELA (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ISELA
Last Name:HERRERA
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 1:4148 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3033
Mailing Address - Country:US
Mailing Address - Phone:602-828-2364
Mailing Address - Fax:
Practice Address - Street 1:521 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4240
Practice Address - Country:US
Practice Address - Phone:602-254-0390
Practice Address - Fax:888-846-8757
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1508829326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine