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General NPI Number Information
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NPI Number | 1851612816
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Entity Type | Organization
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Legal Business Name | DESERT BLOOM FAMILY PRACTICE
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 1925 W ORANGE GROVE RD STE 201
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City | TUCSON
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State | AZ
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Zip | 85704-1151
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Country | US
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Telephone | 520-261-1925
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Fax | 480-393-4402
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Provider Business Mailing Address
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Address Line | 1925 W ORANGE GROVE RD STE 201
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City | TUCSON
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State | AZ
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Zip | 85704-1151
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Country | US
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Telephone | 520-261-1925
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Fax | 480-393-4402
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMY M STROCSHER
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Credential | NP
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Telephone | 520-261-1925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN098206
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License Number State | AZ
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