Provider Demographics
NPI:1578735635
Name:BUSTAMANTE, MARIA J (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:J
Other - Last Name:BUSTAMANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:2325N WYATT DR 105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2121
Mailing Address - Country:US
Mailing Address - Phone:520-324-4774
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5295E KNIGHT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2147
Practice Address - Country:US
Practice Address - Phone:520-324-1010
Practice Address - Fax:520-324-0029
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78444OtherMEDICARE GROUP PTAN
AZ319981OtherAHCCCS
AZ706393OtherAHCCCS GROUP
AZ706393OtherAHCCCS GROUP