Provider Demographics
NPI:1073592499
Name:BUSCH, PATRICE M (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:BUSCH
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 1:8826 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9607
Mailing Address - Country:US
Mailing Address - Phone:520-760-8972
Mailing Address - Fax:520-760-3417
Practice Address - Street 1:8826 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9607
Practice Address - Country:US
Practice Address - Phone:520-760-8972
Practice Address - Fax:520-760-3417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN072920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ358350Medicaid
AZ358350Medicaid
S48019Medicare UPIN