MEDICARE: DESERT BLOOM FAMILY PRACTICE

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	363L00000X	Nurse Practitioner	RN098206	AZ

General Provider Information

NPI Number	:	1851612816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT BLOOM FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	1925 W ORANGE GROVE RD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1151
Country	:	US
Telephone Number	:	520-261-1925
Fax Number	:	480-393-4402

Provider Business Practice Location Address
First Line	:	1925 W ORANGE GROVE RD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1151
Country	:	US
Telephone Number	:	520-261-1925
Fax Number	:	480-393-4402

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AMY M STROCSHER
Credential	:	NP
Telephone Number	:	520-261-1925

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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Directions to “DESERT BLOOM FAMILY PRACTICE ” Practice Location

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