Healthcare Provider Details

I. General information

NPI: 1558081919
Provider Name (Legal Business Name): CHANTEL GATICA-HAYNES DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 E FORT LOWELL RD STE 2
TUCSON AZ
85719-2358
US

IV. Provider business mailing address

1735 E FORT LOWELL RD STE 6
TUCSON AZ
85719-2358
US

V. Phone/Fax

Practice location:
  • Phone: 520-500-1190
  • Fax: 800-628-0799
Mailing address:
  • Phone: 520-500-1190
  • Fax: 800-628-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN176620
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number325870
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: