Healthcare Provider Details

I. General information

NPI: 1679488142
Provider Name (Legal Business Name): ANDREW W MIDDLETON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7089 N THORNYDALE RD STE 101
TUCSON AZ
85741-2728
US

IV. Provider business mailing address

3476 W GREEN RIDGE DR
TUCSON AZ
85741-2703
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF07261578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: