Provider Demographics
NPI:1063143790
Name:ESPINOZA, BERENICE JEACEL (FNP, RN)
Entity type:Individual
Prefix:
First Name:BERENICE
Middle Name:JEACEL
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:BERENICE
Other - Middle Name:JEACEL
Other - Last Name:CAMARENA MOJICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 RIATA VALLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3678
Mailing Address - Country:US
Mailing Address - Phone:928-277-3947
Mailing Address - Fax:
Practice Address - Street 1:3555 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3291
Practice Address - Country:US
Practice Address - Phone:888-209-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN205093363LF0000X
AZRNP279966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily