Provider Demographics
NPI:1104004191
Name:GEMBALA, CAMELIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:
Last Name:GEMBALA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W UNIVERSITY AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2996
Mailing Address - Country:US
Mailing Address - Phone:928-266-1530
Mailing Address - Fax:928-266-1531
Practice Address - Street 1:3939 S PARK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1635
Practice Address - Country:US
Practice Address - Phone:520-745-5001
Practice Address - Fax:520-573-9607
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN122410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ304607Medicaid
AZ304607Medicaid