Basic Information
| Provider Information | |||||||||
| NPI: | 1831784073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | MELINDA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3838 N CAMPBELL AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208742778 | ||||||||
| FaxNumber: | 5206943330 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 E AJO WAY STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857136204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208742720 | ||||||||
| FaxNumber: | 5206943330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 255283 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 255283 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.