Healthcare Provider Details

I. General information

NPI: 1740032309
Provider Name (Legal Business Name): DANIEL MARK GUST MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W AMERICAN AVE
ORACLE AZ
85623-6089
US

IV. Provider business mailing address

1040 W AMERICAN AVE
ORACLE AZ
85623-6089
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-2092
  • Fax:
Mailing address:
  • Phone: 520-471-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP305820
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: