Healthcare Provider Details

I. General information

NPI: 1881333110
Provider Name (Legal Business Name): TAYLOR BRYCE MITCHELL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 W ALVERTON DR
MARANA AZ
85653-8925
US

IV. Provider business mailing address

9089 W ALVERTON DR
MARANA AZ
85653-8925
US

V. Phone/Fax

Practice location:
  • Phone: 520-820-8971
  • Fax:
Mailing address:
  • Phone: 520-820-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number275835
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: