Provider Demographics
NPI:1568697282
Name:ABUNDANT HEALTH FAMILY PRACTICE
Entity Type:Organization
Organization Name:ABUNDANT HEALTH FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:520-326-1457
Mailing Address - Street 1:2055 W HOSPITAL DR
Mailing Address - Street 2:SUITE 295
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7892
Mailing Address - Country:US
Mailing Address - Phone:520-326-1457
Mailing Address - Fax:520-326-1464
Practice Address - Street 1:2055 W HOSPITAL DR
Practice Address - Street 2:SUITE 295
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7892
Practice Address - Country:US
Practice Address - Phone:520-326-1457
Practice Address - Fax:520-326-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ881707Medicaid
AZ526013Medicaid
AZ431655Medicaid
AZZ137338Medicare UPIN
AZ881707Medicaid
AZ526013Medicaid