Healthcare Provider Details

I. General information

NPI: 1114104874
Provider Name (Legal Business Name): HOLLY ANN MONKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 07/12/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E PIMA ST STE 110
TUCSON AZ
85712-3627
US

IV. Provider business mailing address

1477 W COMMERCE CT
TUCSON AZ
85746-6016
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0095
  • Fax: 602-325-2082
Mailing address:
  • Phone: 520-792-3293
  • Fax: 520-792-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30 304786
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN160935
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3543
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: