Healthcare Provider Details

I. General information

NPI: 1851094239
Provider Name (Legal Business Name): LIFESTYLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W GIACONDA WAY STE 105
TUCSON AZ
85704-4350
US

IV. Provider business mailing address

205 W GIACONDA WAY STE 105
TUCSON AZ
85704-4350
US

V. Phone/Fax

Practice location:
  • Phone: 520-409-0845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE JENSEN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 520-409-0845