Basic Information
| Provider Information | |||||||||
| NPI: | 1326419847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNIS-TODD | ||||||||
| FirstName: | ANTIONETTE | ||||||||
| MiddleName: | NMN | ||||||||
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| OtherLastName: | DENNIS- TODD | ||||||||
| OtherFirstName: | ANTIONETTE | ||||||||
| OtherMiddleName: | NMN | ||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18789 S AVENIDA RIO VELOZ | ||||||||
| Address2: | |||||||||
| City: | SAHUARITA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856298172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204076659 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1260 S CAMPBELL AVE | ||||||||
| Address2: | UCHC CONTINENTAL FAMILY MEDICAL CENTER | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856140503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204075900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2015 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP8138 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.