Provider Demographics
NPI:1639846272
Name:CIARDULLI, PATRICIA LEE (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:CIARDULLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:13535 N MARANA MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0990
Mailing Address - Country:US
Mailing Address - Phone:520-887-1010
Mailing Address - Fax:520-433-4900
Practice Address - Street 1:8165 N WADE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-9582
Practice Address - Country:US
Practice Address - Phone:520-887-1010
Practice Address - Fax:520-527-1250
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ097662Medicaid