Healthcare Provider Details

I. General information

NPI: 1609467828
Provider Name (Legal Business Name): JULIE M PIITTMANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 E KNIGHT DR
TUCSON AZ
85712-2147
US

IV. Provider business mailing address

4050 W AERIE DR UNIT 74
TUCSON AZ
85741-2223
US

V. Phone/Fax

Practice location:
  • Phone: 520-307-9094
  • Fax:
Mailing address:
  • Phone: 727-237-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN255044
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9461244
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP255044
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: