Provider Demographics
NPI:1619133253
Name:WILLISON, ALBERT PAUL (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:PAUL
Last Name:WILLISON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70232
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0030
Mailing Address - Country:US
Mailing Address - Phone:520-395-0512
Mailing Address - Fax:520-505-4108
Practice Address - Street 1:5860 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3596
Practice Address - Country:US
Practice Address - Phone:520-395-0512
Practice Address - Fax:520-505-4108
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2910702363L00000X, 363LG0600X
AZAP3237363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP3237OtherSTATE LICENSE
FLARNP2910702OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE