MEDICARE: MS. MARGUERITE ELIZABETH HAVLIS FNP

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	363LF0000X	Family Nurse Practitioner	110937	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568497055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGUERITE ELIZABETH HAVLIS FNP

Provider Business Mailing Address
First Line	:	PO BOX 31235
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85751-1235
Country	:	US
Telephone Number	:	520-324-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4498
Country	:	US
Telephone Number	:	520-324-5090
Fax Number	:	520-324-5236

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/16/2021

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