Healthcare Provider Details

I. General information

NPI: 1639292311
Provider Name (Legal Business Name): NANCY JOYCE PETTIBON CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N EL DORADO PL BLD E SUITE 520
TUCSON AZ
85715-4637
US

IV. Provider business mailing address

9040 E BEAR CREEK DR
TUCSON AZ
85749-9642
US

V. Phone/Fax

Practice location:
  • Phone: 520-209-2500
  • Fax: 520-545-7250
Mailing address:
  • Phone: 253-720-3117
  • Fax: 520-545-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN180728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: