Basic Information
Provider Information
NPI: 1144753906
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLORES-JURADO
FirstName: CHRISTINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 33269
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850673269
CountryCode: US
TelephoneNumber: 6024064786
FaxNumber: 9166364358
Practice Location
Address1: 655 S DOBSON RD STE B113
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852245667
CountryCode: US
TelephoneNumber: 4807285020
FaxNumber: 4808995023
Other Information
ProviderEnumerationDate: 04/09/2017
LastUpdateDate: 03/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP9950AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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