Healthcare Provider Details

I. General information

NPI: 1821243692
Provider Name (Legal Business Name): ROBERT DANIEL TAVANI FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 N 7TH ST STE. 200
PHOENIX AZ
85014-5059
US

IV. Provider business mailing address

3707 N 7TH ST STE. 200
PHOENIX AZ
85014-5059
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-9100
  • Fax: 602-264-9101
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3210
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: