Provider Demographics
NPI:1275933178
Name:PACKER, ACACIA (DO)
Entity Type:Individual
Prefix:
First Name:ACACIA
Middle Name:
Last Name:PACKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ACACIA
Other - Middle Name:
Other - Last Name:SZWEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245085
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5085
Mailing Address - Country:US
Mailing Address - Phone:520-694-7432
Mailing Address - Fax:520-694-6688
Practice Address - Street 1:3043 W INA RD STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2107
Practice Address - Country:US
Practice Address - Phone:520-797-7070
Practice Address - Fax:520-797-7077
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR2505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics