MEDICARE: MR. MATTHEW DAVID MICHAUD FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	279320	AZ

General Provider Information

NPI Number	:	1053045948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW DAVID MICHAUD FNP

Provider Business Mailing Address
First Line	:	4801 E BROADWAY BLVD STE 251
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3633
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	2260 N ROSEMONT BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2137
Country	:	US
Telephone Number	:	520-318-1033
Fax Number	:	520-318-1338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2022
Last Update Date	:	04/07/2026

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