Healthcare Provider Details

I. General information

NPI: 1609703602
Provider Name (Legal Business Name): BRYANN TARA-MICHELLE VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 W ORANGE GROVE RD APT 1107
TUCSON AZ
85704-5668
US

IV. Provider business mailing address

645 W ORANGE GROVE RD APT 1107
TUCSON AZ
85704-5668
US

V. Phone/Fax

Practice location:
  • Phone: 520-979-9433
  • Fax:
Mailing address:
  • Phone: 520-979-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number241871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: