Provider Demographics
NPI:1306698469
Name:GASTON, ANN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GASTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12647 N GOLDEN JUBILEE DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7708
Mailing Address - Country:US
Mailing Address - Phone:520-270-2271
Mailing Address - Fax:
Practice Address - Street 1:1676 E MCMURRAY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4798
Practice Address - Country:US
Practice Address - Phone:520-316-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily