Healthcare Provider Details

I. General information

NPI: 1396196986
Provider Name (Legal Business Name): TAMMI LYNN BANCROFT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2016
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 W 4TH ST STE B
BENSON AZ
85602-6566
US

IV. Provider business mailing address

8386 S EGYPTIAN DR
TUCSON AZ
85747-5995
US

V. Phone/Fax

Practice location:
  • Phone: 520-221-8280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: