Healthcare Provider Details

I. General information

NPI: 1295234615
Provider Name (Legal Business Name): EMERALD CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY BLVD STE 1600
TUCSON AZ
85711-3777
US

IV. Provider business mailing address

6890 E SUNRISE DR # 120-305
TUCSON AZ
85750-0738
US

V. Phone/Fax

Practice location:
  • Phone: 520-314-1545
  • Fax: 520-300-7326
Mailing address:
  • Phone: 520-314-1545
  • Fax: 520-300-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ABRAMS
Title or Position: OWNER
Credential: RN
Phone: 520-314-1545