Provider Demographics
NPI:1588215743
Name:CLEMONS, MARGARITA (NP)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:CLEMONS
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 1:4990 E MEDITERRANEAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2495
Mailing Address - Country:US
Mailing Address - Phone:520-439-5186
Mailing Address - Fax:520-439-4466
Practice Address - Street 1:4990 E MEDITERRANEAN DR STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2495
Practice Address - Country:US
Practice Address - Phone:520-439-5186
Practice Address - Fax:520-439-4466
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTEMP232616363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health