Provider Demographics
NPI:1538283650
Name:TAPIA, MARY (FNP/CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:TAPIA
Suffix:
Gender:F
Credentials:FNP/CNM
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:TAPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3132 STIX RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-6917
Mailing Address - Country:US
Mailing Address - Phone:505-870-7879
Mailing Address - Fax:
Practice Address - Street 1:3132 STIX RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-6917
Practice Address - Country:US
Practice Address - Phone:505-870-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN155657163WW0101X, 363LF0000X, 367A00000X
CARN155657363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1780614008Medicaid
AZ697360Medicaid
AZ1629236716Medicaid
AZ1871523191Medicaid
AZ1295993376Medicaid
AZ1780614008Medicaid