Healthcare Provider Details

I. General information

NPI: 1467306217
Provider Name (Legal Business Name): NICOL SHANTEL EBANKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

IV. Provider business mailing address

2171 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-3907
  • Fax:
Mailing address:
  • Phone: 520-297-3907
  • Fax: 520-989-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: