Provider Demographics
NPI:1083771893
Name:ALLISON, THERESA (NP)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:NP
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 35837
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5837
Mailing Address - Country:US
Mailing Address - Phone:520-909-4465
Mailing Address - Fax:
Practice Address - Street 1:5080 N RIVER FRINGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-909-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN070019363L00000X
AZAP2176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961062Medicaid
AZ961062001OtherMERCYCARE PLAN
AZ961062OtherPIMA HEALTH SYSTEMS
AZ961062OtherPIMA HEALTH SYSTEMS