Healthcare Provider Details

I. General information

NPI: 1154267037
Provider Name (Legal Business Name): NOA MARIE STOTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

IV. Provider business mailing address

4316 W HAPPY TRL
LAVEEN AZ
85339-2062
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-5461
  • Fax:
Mailing address:
  • Phone: 602-320-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11911
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: