Healthcare Provider Details

I. General information

NPI: 1831807478
Provider Name (Legal Business Name): MIRANDA GEBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 N ORACLE RD
TUCSON AZ
85705-1770
US

IV. Provider business mailing address

6945 W SAUCEDA DR
TUCSON AZ
85743-1423
US

V. Phone/Fax

Practice location:
  • Phone: 520-887-0095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: