Healthcare Provider Details

I. General information

NPI: 1134613938
Provider Name (Legal Business Name): MICHELLE ANN CAMBERN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ANN POPOFF

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WILMOT RD
TUCSON AZ
85711-2602
US

IV. Provider business mailing address

16053 W WILSHIRE DR
GOODYEAR AZ
85395-7603
US

V. Phone/Fax

Practice location:
  • Phone: 520-873-3000
  • Fax:
Mailing address:
  • Phone: 602-430-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCAPN0101820CNP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033277
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14039411-4405
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number219809
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN098743
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61581069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: