MEDICARE: JACKIE LAIWAH CAMARGO FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	AP5480	AZ

General Provider Information

NPI Number	:	1669897468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE LAIWAH CAMARGO FNP-C

Provider Business Mailing Address
First Line	:	10501 E SEVEN GENERATIONS WAY STE 201-16
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-358-2025
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 E SEVEN GENERATIONS WAY STE 201-16
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-358-2025
Fax Number	:

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

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	07/24/2024

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