=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023716149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSA SUSANA ABARCA FNP-BC, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2023
-----------------------------------------------------
Last Update Date | 03/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 E 40TH ST, YUMA, AZ 85365
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-373-6743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4466 W 13TH PL
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-8439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-246-8477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 287618
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------