Provider Demographics
NPI:1568485951
Name:GUMM, COLLEEN ANNE (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:GUMM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2558
Mailing Address - Country:US
Mailing Address - Phone:520-468-4801
Mailing Address - Fax:520-337-7268
Practice Address - Street 1:3902 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2558
Practice Address - Country:US
Practice Address - Phone:520-468-4801
Practice Address - Fax:520-337-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN104226163WG0600X
AZAP2459363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology