LICEETT PENA (NPI# 1740705961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740705961 |
| Entity Type | Individual |
| Full Name | LICEETT PENA |
| Credential | FNP-C |
| Practice Address |
616 E Southern Ave Ste 103 Mesa AZ 85204 |
| Mailing Address |
1533 E Willetta St Phoenix AZ 85006-2935 |
| Practice Telephone | 6025693999 |
| Practice Fax Number | 6025693887 |
| Mailing Telephone | 6025693999 |
| Mailing Fax Number | 6025693887 |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2018-09-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN182545 | AZ | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP11544 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1315 W Southern Ave, Tempe, AZ 852824519 | 6025693999 | 6025693887 |
| 13402 N 32nd St Ste 5, Phoenix, AZ 850326047 | 6025693999 | 6025693887 |
| 1533 E Willetta St, Phoenix, AZ 850062935 | 6025693999 | 6025693887 |
| 301 E Cottonwood Ln Ste 12, Casa Grande, AZ 851222551 | 6025693999 | 6025693887 |
| 7734 N 59th Ave, Glendale, AZ 853017816 | 6025693999 | 6025693887 |
| Street Address |
616 E SOUTHERN AVE STE 103 |
| City | MESA |
| State | AZ |
| Zip Code | 85204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306141213 | Freddy L Montenegro | Nurse Practitioner | 616 E Southern Ave Ste 103, Mesa, AZ 85204 | 2011-01-24 |
| 1104457621 | Erick Torres | Nurse Practitioner | 616 E Southern Ave Ste 103, Mesa, AZ 85204-4941 | 2020-02-03 |
| 1407337785 | Jennyfer Nayeli Willford | Nurse Practitioner | 616 E Southern Ave Ste 103, Mesa, AZ 85204-4941 | 2018-08-24 |
| 1508377789 | Sandy Pauline Morales | Physician Assistant | 616 E Southern Ave Ste 103, Mesa, AZ 85204-4941 | 2017-10-16 |
| 1770019721 | Evelyn Lozoya | Nurse Practitioner | 616 E Southern Ave Ste 103, Mesa, AZ 85204-4941 | 2017-05-11 |
| 1558635045 | Alex Guzman Garcia | Physician Assistant | 616 E Southern Ave Ste 103, Mesa, AZ 85204-4941 | 2012-02-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194374819 | Luminations Healing Center, LLC | Social Worker | 1237 S. Val Vista Dr. #221, Mesa, AZ 85204 | 2019-09-05 |
| 1881160356 | Wanjiru Landers | Student in an Organized Health Care Education/Training Program | 550 S Linda Circle, Mesa, AZ 85204 | 2018-10-22 |
| 1649754235 | Adam Desnous | Specialist/Technologist | 751 S Daley, Mesa, AZ 85204 | 2018-09-19 |
| 1982128187 | Michael Anthony Jones | Counselor | 1107 North Gilbert Rd, Mesa, AZ 85204 | 2017-07-29 |
| 1295287225 | Scottsdale Healthcare Corp | Family Medicine | 2530 W. Southern Ave, Mesa, AZ 85204 | 2016-10-25 |
| 1427504158 | Richard White | Physician Assistant | 2345 E Southern Ave # 101, Mesa, AZ 85204 | 2016-09-01 |
| 1548716780 | Pain Stop Accident Injury LLC | Chiropractor | 425 E 11th Ave, Mesa, AZ 85204 | 2016-08-28 |
| 1154704252 | Glenn Taylor Lesueur | Dentist | 1056 S. Val Vista Dr., Suite 1, Mesa, AZ 85204 | 2015-07-07 |
| 1073932513 | Naomi Devine | Nurse Practitioner | 1840 South Stapley Drive, Suite 101, Mesa, AZ 85204 | 2014-04-14 |
| 1609292531 | John Kamau | Counselor | 1060 S Lobin Ln, Mesa, AZ 85204 | 2014-03-17 |
| Find all providers in zip 85204 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926410 | Matthew Derrick Miller | Nurse Practitioner | 9354 E Thatcher Cir, Mesa, AZ 85212-8539 | 2020-09-12 |
| 1750995858 | Hayley Madler | Nurse Practitioner | 1061 N Omaha Cir, Mesa, AZ 85205-5023 | 2020-09-04 |
| 1043823800 | Nancy Lynn Mitchell | Nurse Practitioner | 1535 N 26th St, Mesa, AZ 85213-4151 | 2020-08-30 |
| 1003429218 | Krista Ann Clevenger | Nurse Practitioner | 3155 E Southern Ave Ste 203, Mesa, AZ 85204-5521 | 2020-08-26 |
| 1093326290 | Joshua Jackson | Nurse Practitioner | 5432 E Southern Ave Ste 101b, Mesa, AZ 85206-2772 | 2020-08-11 |
| 1790395531 | Kelly C Banonis | Nurse Practitioner | 3322 N Brighton, Mesa, AZ 85207-0997 | 2020-08-06 |
| 1689284911 | Katie Keil | Nurse Practitioner | 1061 N Dobson Rd Ste 107, Mesa, AZ 85201-7576 | 2020-08-02 |
| 1831711670 | Saraswati Hamal | Nurse Practitioner | 4850 S Curie Way, Mesa, AZ 85212-9582 | 2020-05-14 |
| 1013539568 | Wingfoot Wellness & Hormones LLC | Nurse Practitioner | 2500 S Power Road, Building 7 Suite 218, Mesa, AZ 85209 | 2020-05-07 |
| 1659992436 | Elizabeth Erb | Nurse Practitioner | 1361 S Alma School Rd, Mesa, AZ 85210-2085 | 2020-05-02 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.