Healthcare Provider Details

I. General information

NPI: 1861672081
Provider Name (Legal Business Name): SONIA JEAN SHOUP APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 E RINCON CREEK RANCH RD
TUCSON AZ
85747
US

IV. Provider business mailing address

3003 N CENTRAL AVE
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 832-266-9942
  • Fax:
Mailing address:
  • Phone: 832-266-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP7803
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: