Provider Demographics
NPI:1639129299
Name:POLSON, PATRICIA S (MSN/FNP, CRNFA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:POLSON
Suffix:
Gender:F
Credentials:MSN/FNP, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:#205
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-584-5626
Mailing Address - Fax:623-584-8998
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:#205
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-584-5626
Practice Address - Fax:623-584-8998
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF0604150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5124334OtherAETNA
AZ730511OtherUNITED HEALTHCARE
AZP0185990OtherBCBS OUT OF AREA
AZ1912990094OtherAHCCCS
AZ2Z3248OtherHEALTHNET
AZQ20920Medicare UPIN
AZ5124334OtherAETNA
AZZWCLCJMedicare PIN
Z82582Medicare PIN
AZ20WCLCJ01Medicare PIN