Healthcare Provider Details

I. General information

NPI: 1962322800
Provider Name (Legal Business Name): MONICA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1055 N LA CANADA DR
TUCSON AZ
85705-2846
US

V. Phone/Fax

Practice location:
  • Phone: 928-710-2306
  • Fax:
Mailing address:
  • Phone: 928-710-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number341833
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: