Healthcare Provider Details

I. General information

NPI: 1881140259
Provider Name (Legal Business Name): TANDRA A GARVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANDRA A CRUMEDY

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2737
US

IV. Provider business mailing address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2737
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8943
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8943
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: