Individual provider Active NPI

Jeremy Lee Gianzero, RN

  • Family Nurse Practitioner
  • San Tan Valley, AZ
National Provider Identifier
1417218595
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
328243 Issued in AZ
Practice address
783 E Chelsea Dr
San Tan Valley, AZ 85140-5561
Phone
(719) 238-5317
NPI assigned
Jun 5, 2012
Last updated
Aug 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 328243 AZ Primary
Registered Nurse 163W00000X 186628 CO

Addresses

Primary practice location

783 E Chelsea Dr
San Tan Valley, AZ 85140-5561

Mailing address

783 E Chelsea Dr
San Tan Valley, AZ 85140-5561
Phone (719) 238-5317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251031003592 AZ Practitioner - Nurse Practitioner 4688163280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fiesta Health Services LLCGroup PAC ID 5294031068, 5 clinicians

Practice addresses (Care Compare)

1303 S Longmore
Suite 8
Mesa, AZ 85202-9607
Phone (480) 649-5297

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
186628COMDRegistered Nurse
328243AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fiesta Health Services LLC CurrentSince Aug 4, 2025 Accepting new patients

Locations

1234 S Power Rd
Ste 202
Mesa, AZ 85206
Phone (480) 649-5297

1303 S Longmore
Ste 8
Mesa, AZ 85202
Phone (480) 464-1030

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1417218595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "783 E CHELSEA DR",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851405561",
            "telephone_number": "719-238-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "783 E CHELSEA DR",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851405561",
            "telephone_number": "719-238-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIANZERO",
        "first_name": "JEREMY",
        "middle_name": "LEE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-05",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "328243",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "186628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

Verify at the official NPI Registry.