Healthcare Provider Details

I. General information

NPI: 1649150491
Provider Name (Legal Business Name): JESSICA MIRANDA FRIAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 10/24/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E UNIVERSITY BLVD
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

215 W PORTLAND ST UNIT 148C
PHOENIX AZ
85003-5428
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-2211
  • Fax:
Mailing address:
  • Phone: 623-505-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number314102
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: