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General NPI Number Information
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NPI Number | 1427680131
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Entity Type | Individual
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Provider Name | SPENCER JUDD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 350 N WILMOT RD
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City | TUCSON
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State | AZ
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Zip | 85711-2602
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Country | US
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Telephone | 520-873-3836
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Fax |
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Provider Business Mailing Address
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Address Line | 27 S SHADOW CREEK PL
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City | TUCSON
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State | AZ
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Zip | 85748-3270
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Country | US
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Telephone | 520-869-8984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 239907
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN128111
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License Number State | AZ
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