Healthcare Provider Details

I. General information

NPI: 1053895706
Provider Name (Legal Business Name): SANDRA PULLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 W ORANGE GROVE RD STE 101
TUCSON AZ
85704-1289
US

IV. Provider business mailing address

1871 W ORANGE GROVE RD STE 101
TUCSON AZ
85704-1289
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-8342
  • Fax:
Mailing address:
  • Phone: 520-219-8342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: