Healthcare Provider Details

I. General information

NPI: 1457179004
Provider Name (Legal Business Name): MARCUS FIFE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 S HOUGHTON RD STE 150
TUCSON AZ
85747-9725
US

IV. Provider business mailing address

8290 S HOUGHTON RD
TUCSON AZ
85747-9723
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-1045
  • Fax:
Mailing address:
  • Phone: 520-694-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236841
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: