Healthcare Provider Details

I. General information

NPI: 1124371505
Provider Name (Legal Business Name): HOLLY TUKUAFU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E ELLIOT RD
GILBERT AZ
85234-1304
US

IV. Provider business mailing address

2652 E HALE ST
MESA AZ
85213-4149
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2801
  • Fax:
Mailing address:
  • Phone: 480-892-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN100484
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: