Healthcare Provider Details

I. General information

NPI: 1962711648
Provider Name (Legal Business Name): SYLVIA QUEVEDO NICHOLSON MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N LA CANADA DR STE 121
GREEN VALLEY AZ
85614-3700
US

IV. Provider business mailing address

4801 E BROADWAY BLVD STE 251
TUCSON AZ
85711-3633
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-7770
  • Fax: 520-547-7775
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: