Provider Demographics
NPI:1043641178
Name:EUBANKS, DONNA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ANN
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N WYATT DRIVE
Mailing Address - Street 2:SUITE 71
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-318-1860
Mailing Address - Fax:520-318-1859
Practice Address - Street 1:2320 N WYATT DRIVE
Practice Address - Street 2:SUITE 71
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-318-1860
Practice Address - Fax:520-318-1859
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAHCCCS # 886697Medicaid
AZAHCCCS # 886697Medicaid