MEDICARE: DEEPA TANDON CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	SP013927	PA

General Provider Information

NPI Number	:	1053727768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA TANDON CRNP

Provider Business Mailing Address
First Line	:	PO BOX 21630
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85277-1630
Country	:	US
Telephone Number	:	480-985-1093
Fax Number	:	480-296-7665

Provider Business Practice Location Address
First Line	:	4065 E BELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2208
Country	:	US
Telephone Number	:	480-985-1093
Fax Number	:	480-296-7665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	09/25/2023

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