MEDICARE: JANELL NICOLE SOTO NP-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	363LF0000X	Family Nurse Practitioner	AP11819	AZ

General Provider Information

NPI Number	:	1922575067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELL NICOLE SOTO NP-C

Provider Business Mailing Address
First Line	:	445 N SILVERBELL RD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2686
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 N SILVERBELL RD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2686
Country	:	US
Telephone Number	:	520-396-1370
Fax Number	:	520-396-1375

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

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/01/2019

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