Provider Demographics
NPI:1104805399
Name:WIGGIN, BARBARA M (PHD, ANP-C)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:WIGGIN
Suffix:
Gender:F
Credentials:PHD, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54459
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85078-4459
Mailing Address - Country:US
Mailing Address - Phone:602-977-1212
Mailing Address - Fax:623-875-1815
Practice Address - Street 1:13000 N 103RD AVE STE 73
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3056
Practice Address - Country:US
Practice Address - Phone:623-977-1212
Practice Address - Fax:623-875-1815
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2188363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z24579Medicare PIN
AZS83683Medicare UPIN