Healthcare Provider Details

I. General information

NPI: 1205619830
Provider Name (Legal Business Name): KRYSTAN M VERNETTI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAN M MCDANIEL

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

7998 N PANAMINT DR
TUCSON AZ
85743-1184
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 719-431-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number296396
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0105381-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: