Provider Demographics
NPI:1518215706
Name:LOPEZCARDENAS, BETTINA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:
Last Name:LOPEZCARDENAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 E GRANT RD STE 261
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2776
Mailing Address - Country:US
Mailing Address - Phone:520-297-1345
Mailing Address - Fax:
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:STE 315
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2980
Practice Address - Country:US
Practice Address - Phone:520-618-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner