Provider Demographics
NPI:1285015503
Name:HACKETT, JAMES BENJAMIN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:HACKETT
Suffix:
Gender:M
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 1:3709 N CAMPBELL AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-297-3907
Mailing Address - Fax:520-989-3486
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
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291763163W00000X
AZRN141174163WF0300X
AZAP8200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WF0300XNursing Service ProvidersRegistered NurseFlight
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP8200OtherARIZONA STATE BOARD OF NURSING
AZRN141174OtherAZ LICENSE