Healthcare Provider Details

I. General information

NPI: 1972726818
Provider Name (Legal Business Name): THERESA JOAN SPARICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 W AJO WAY
TUCSON AZ
85713-5738
US

IV. Provider business mailing address

8332 E DESERT STEPPES DR
TUCSON AZ
85710-4206
US

V. Phone/Fax

Practice location:
  • Phone: 520-908-4047
  • Fax: 520-908-4001
Mailing address:
  • Phone: 520-721-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN082670
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: