Healthcare Provider Details

I. General information

NPI: 1043641178
Provider Name (Legal Business Name): DONNA ANN EUBANKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N WYATT DRIVE SUITE 71
TUCSON AZ
85712
US

IV. Provider business mailing address

2320 N WYATT DRIVE SUITE 71
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-1860
  • Fax: 520-318-1859
Mailing address:
  • Phone: 520-318-1860
  • Fax: 520-318-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: