MEDICARE: SUSANA OPHELIA MARR 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	363LF0000X	Family Nurse Practitioner	RNP-333979	AZ

General Provider Information

NPI Number	:	1982553848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA OPHELIA MARR FNP-C

Provider Business Mailing Address
First Line	:	2980 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6267
Country	:	US
Telephone Number	:	520-724-8491
Fax Number	:	520-770-4120

Provider Business Practice Location Address
First Line	:	2980 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6267
Country	:	US
Telephone Number	:	520-724-8491
Fax Number	:	520-770-4120

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

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

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