Healthcare Provider Details

I. General information

NPI: 1033731484
Provider Name (Legal Business Name): VANESSA LISA AULET FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N CATALINA AVE
TUCSON AZ
85711-1132
US

IV. Provider business mailing address

333 E WETMORE RD
TUCSON AZ
85705-1720
US

V. Phone/Fax

Practice location:
  • Phone: 407-209-6712
  • Fax:
Mailing address:
  • Phone: 882-290-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number254802
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number254802
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9355270
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11007124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: