Provider Demographics
NPI:1598423105
Name:PREVATKE, MICAELA ROSE (NP)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:ROSE
Last Name:PREVATKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:
Other - Last Name:PREVATKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MICAELA FRICCHIONE
Mailing Address - Street 1:6393 W SMOKY FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-6996
Mailing Address - Country:US
Mailing Address - Phone:928-581-6161
Mailing Address - Fax:
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-742-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ179686163W00000X
AZ269731363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse