Healthcare Provider Details

I. General information

NPI: 1750556916
Provider Name (Legal Business Name): MARYROSE DEGUZMAN RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 N STONE AVE
TUCSON AZ
85704-5727
US

IV. Provider business mailing address

4821 N STONE AVE
TUCSON AZ
85704-5727
US

V. Phone/Fax

Practice location:
  • Phone: 520-314-3300
  • Fax: 520-293-1957
Mailing address:
  • Phone: 520-314-3300
  • Fax: 520-293-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberF334858
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4332
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: