Healthcare Provider Details

I. General information

NPI: 1093631657
Provider Name (Legal Business Name): MELISSA FOGEL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N CAMPBELL AVE STE 201-5
TUCSON AZ
85719-3163
US

IV. Provider business mailing address

PO BOX 85024
TUCSON AZ
85754-5024
US

V. Phone/Fax

Practice location:
  • Phone: 520-368-0984
  • Fax:
Mailing address:
  • Phone: 520-368-0984
  • Fax: 520-372-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number303697
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: