MEDICARE: JONNI STOCKDALE NP

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	TAP2849	AZ

General Provider Information

NPI Number	:	1750579470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONNI STOCKDALE NP

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	888-771-1874
Fax Number	:	401-770-1998

Provider Business Practice Location Address
First Line	:	8920 E TANQUE VERDE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-9604
Country	:	US
Telephone Number	:	886-389-2727
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	01/26/2019

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