Healthcare Provider Details

I. General information

NPI: 1043240591
Provider Name (Legal Business Name): CYNTHIA SUE MICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 N WYATT DR
TUCSON AZ
85712
US

IV. Provider business mailing address

529 W WETMORE RD
TUCSON AZ
85705
US

V. Phone/Fax

Practice location:
  • Phone: 520-624-1761
  • Fax: 520-622-8743
Mailing address:
  • Phone: 520-628-3073
  • Fax: 520-628-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN034985
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: