Provider Demographics
NPI:1942059993
Name:GRIJALVA, ELIZABETH (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 PLACITA CABALLO
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-5299
Mailing Address - Country:US
Mailing Address - Phone:520-339-1976
Mailing Address - Fax:
Practice Address - Street 1:6911 N BDI BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-6202
Practice Address - Country:US
Practice Address - Phone:520-364-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily