Healthcare Provider Details

I. General information

NPI: 1386046167
Provider Name (Legal Business Name): SUSAN M LEBOUEF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6390 E BROADWAY BLVD
TUCSON AZ
85710-3517
US

IV. Provider business mailing address

2601 S HOUGHTON RD
TUCSON AZ
85730-1525
US

V. Phone/Fax

Practice location:
  • Phone: 520-733-2250
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN118990
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: