Healthcare Provider Details

I. General information

NPI: 1154047629
Provider Name (Legal Business Name): MRS. RAQUEL CIDONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 E BROADWAY BLVD APT 166
TUCSON AZ
85710-3926
US

IV. Provider business mailing address

8111 E BROADWAY BLVD APT 166
TUCSON AZ
85710-3926
US

V. Phone/Fax

Practice location:
  • Phone: 520-724-0682
  • Fax: 877-384-3106
Mailing address:
  • Phone: 520-724-0682
  • Fax: 877-384-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN200272
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number288350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: