=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073010468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI LYNN BLETH DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2018
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 N SABINO CANYON RD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85750-6435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-614-6636
-----------------------------------------------------
Fax | 520-614-6638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5005 N CALLE ESQUINA
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85718-6337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-210-2623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP10992
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------