Healthcare Provider Details

I. General information

NPI: 1063712537
Provider Name (Legal Business Name): VICTORIA ANN TWEEDY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

IV. Provider business mailing address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-4747
  • Fax: 623-334-4400
Mailing address:
  • Phone: 623-777-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: