Healthcare Provider Details

I. General information

NPI: 1700729654
Provider Name (Legal Business Name): SIERRA IXTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12480 N RANCHO VISTOSO BLVD STE 180
ORO VALLEY AZ
85755-1994
US

IV. Provider business mailing address

12480 N RANCHO VISTOSO BLVD STE 180
ORO VALLEY AZ
85755-1994
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-4008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number120788324405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: