Basic Information
| Provider Information | |||||||||
| NPI: | 1063712537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TWEEDY | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13203 N 103RD AVE | ||||||||
| Address2: | STE H5 | ||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237774747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13203 N 103RD AVE STE H5 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237774747 | ||||||||
| FaxNumber: | 6233344400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2010 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP3850 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 570267 | 05 | AZ | MEDICAID |