Healthcare Provider Details

I. General information

NPI: 1699033639
Provider Name (Legal Business Name): THERESA DANZALAN JONES DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 N WYATT DR
TUCSON AZ
85712-2121
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-1510
  • Fax: 520-616-1511
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-818-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11083
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN136556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: