Healthcare Provider Details

I. General information

NPI: 1306565262
Provider Name (Legal Business Name): ANDREA ROTH CRAIG DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E 5TH ST STE 101
TUCSON AZ
85711-2415
US

IV. Provider business mailing address

4801 E BROADWAY BLVD STE 251
TUCSON AZ
85711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-4181
  • Fax: 520-721-7536
Mailing address:
  • Phone: 520-327-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN203861
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335472
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: