Provider Demographics
NPI:1386088649
Name:WIGGINS, CRAIG ANGELO (FNP)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANGELO
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:4801 E MCDOWELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7725
Mailing Address - Country:US
Mailing Address - Phone:602-954-3919
Mailing Address - Fax:602-954-3670
Practice Address - Street 1:9305 W THOMAS RD STE 305
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3366
Practice Address - Country:US
Practice Address - Phone:623-478-8000
Practice Address - Fax:623-478-8003
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP4898207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ914972Medicaid
AZ914972Medicaid