Provider Demographics
NPI:1659651172
Name:TATE, SETH JACOB (FNP)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:JACOB
Last Name:TATE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 N ORACLE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9378
Mailing Address - Country:US
Mailing Address - Phone:520-585-5878
Mailing Address - Fax:844-205-6998
Practice Address - Street 1:10515 N ORACLE RD STE 185
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9378
Practice Address - Country:US
Practice Address - Phone:520-585-5878
Practice Address - Fax:844-205-6998
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6170200-4405363LF0000X
OR201150077NP363LF0000X
AZAP4637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z90637OtherMEDICARE
03-1828OtherMEDICARE
AZ731654Medicaid
Z61788OtherMEDICARE