Healthcare Provider Details

I. General information

NPI: 1679491427
Provider Name (Legal Business Name): NICHOLAS GLEN STRUVE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2030 E BROADWAY BLVD
TUCSON AZ
85719-5905
US

IV. Provider business mailing address

2030 E BROADWAY BLVD
TUCSON AZ
85719-5905
US

V. Phone/Fax

Practice location:
  • Phone: 520-310-6925
  • Fax:
Mailing address:
  • Phone: 520-310-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number333870
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: