Healthcare Provider Details

I. General information

NPI: 1558973008
Provider Name (Legal Business Name): NATHAN QUITASOL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N MARTIN AVE
TUCSON AZ
85721-9480
US

IV. Provider business mailing address

3665 E SUNDANCE AVE
GILBERT AZ
85297-9480
US

V. Phone/Fax

Practice location:
  • Phone: 480-650-8373
  • Fax:
Mailing address:
  • Phone: 480-650-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number236539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: