Healthcare Provider Details

I. General information

NPI: 1801463203
Provider Name (Legal Business Name): HEATHER WATERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9348 E RITA RD STE 140
TUCSON AZ
85747-6301
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-1036
  • Fax: 520-324-1035
Mailing address:
  • Phone: 520-324-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP253287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: