Healthcare Provider Details

I. General information

NPI: 1407427164
Provider Name (Legal Business Name): RACHEL LYNN HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W PRINCE RD
TUCSON AZ
85705-3114
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-887-0800
  • Fax: 520-887-1393
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-616-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number258988
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: