Provider Demographics
NPI:1043601040
Name:NELSON, GLORIAJEAN (FNP-C, CWOCN)
Entity Type:Individual
Prefix:
First Name:GLORIAJEAN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2308
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:70 N HARRISON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-3260
Practice Address - Country:US
Practice Address - Phone:520-324-4403
Practice Address - Fax:520-324-1409
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN163032163WW0000X, 163WX1500X, 163WC2100X
AZAP7644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ229692OtherMEDICARE
AZ006233Medicaid