Healthcare Provider Details

I. General information

NPI: 1215368964
Provider Name (Legal Business Name): LUCY PITTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax:
Mailing address:
  • Phone: 602-462-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5335
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: