Healthcare Provider Details

I. General information

NPI: 1558085787
Provider Name (Legal Business Name): JUSTIN DANIEL HUTCHINS AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7170
US

IV. Provider business mailing address

3851 W 36TH ST
YUMA AZ
85365-7978
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2400
  • Fax:
Mailing address:
  • Phone: 928-304-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberPENDING
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: