Healthcare Provider Details

I. General information

NPI: 1053859595
Provider Name (Legal Business Name): ALICE C DASTRUP ARNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE CELESTE BALLARD RN

II. Dates (important events)

Enumeration Date: 02/04/2017
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N LA CHOLLA BLVD
TUCSON AZ
85741-3529
US

IV. Provider business mailing address

3100 WESTON RD
WESTON FL
33331-3602
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-9000
  • Fax:
Mailing address:
  • Phone: 972-816-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA223045
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number327097
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9373496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: