Healthcare Provider Details

I. General information

NPI: 1578735635
Provider Name (Legal Business Name): MARIA J BUSTAMANTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA J BUSTAMANTE NP-C

II. Dates (important events)

Enumeration Date: 03/29/2008
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295E KNIGHT DR
TUCSON AZ
85712-2147
US

IV. Provider business mailing address

2325N WYATT DR 105
TUCSON AZ
85712-2121
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-1010
  • Fax: 520-324-0029
Mailing address:
  • Phone: 520-324-4774
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2996
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: