Healthcare Provider Details

I. General information

NPI: 1497259329
Provider Name (Legal Business Name): PEGGY LYNN CANALES AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-505-2476
Mailing address:
  • Phone: 520-694-8888
  • Fax: 520-505-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024175994
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number311810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: