Provider Demographics
NPI:1235433426
Name:STROUT, DAVID LIONEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LIONEL
Last Name:STROUT
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2122
Mailing Address - Fax:520-838-2245
Practice Address - Street 1:4729 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1256
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2021-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN105548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ780072Medicaid