Healthcare Provider Details

I. General information

NPI: 1760107932
Provider Name (Legal Business Name): JAMIE HOANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W ORANGE GROVE RD STE 104
TUCSON AZ
85704-1140
US

IV. Provider business mailing address

2001 W ORANGE GROVE RD STE 104
TUCSON AZ
85704-1140
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9345
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: