Healthcare Provider Details

I. General information

NPI: 1942684253
Provider Name (Legal Business Name): ROBERTA BOON F.N.P.-B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBERTA BROWNING BOON F.N.P.-B.C.

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 N WYATT DR STE 101
TUCSON AZ
85712-2120
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-4948
  • Fax: 520-616-4958
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-682-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1091692
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1091692
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: