MEDICARE: MS. MARIE MCDERMOTT MSN, NP-C

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	AP3913	AZ

General Provider Information

NPI Number	:	1407151418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE MCDERMOTT MSN, NP-C

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	7395 E TANQUE VERDE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3475
Country	:	US
Telephone Number	:	520-547-2311
Fax Number	:	520-547-2320

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/20/2026

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