Individual
MARISOL TATIANA AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P-C
Contact information
Practice address
1311 E THOMAS RD, PHOENIX, AZ 85014-5707
(602) 322-1315
(602) 889-7392
Mailing address
1311 E THOMAS RD, PHOENIX, AZ 85014-5707
(602) 322-1315
(602) 889-7392
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP2288
AZ
363LF0000X
Family Nurse Practitioner
RN135266
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486122
—
AZ
01
—
RN135266
AZ STATE LICENSE #
AZ
Enumeration date
06/07/2007
Last updated
02/07/2025
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