Provider Demographics
NPI:1679000533
Name:ACQUAFREDDA, ANGELA MARIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:ACQUAFREDDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:TOVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:645 E MISSOURI AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1349
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:15215 S 48TH ST STE 161
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9139
Practice Address - Country:US
Practice Address - Phone:602-633-4493
Practice Address - Fax:602-716-9656
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10008363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily