Provider Demographics
NPI:1679659916
Name:YURGEL, JUDITH TERESA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:TERESA
Last Name:YURGEL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86537
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-6537
Mailing Address - Country:US
Mailing Address - Phone:520-721-1887
Mailing Address - Fax:520-372-7126
Practice Address - Street 1:107 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-2506
Practice Address - Country:US
Practice Address - Phone:520-466-7765
Practice Address - Fax:520-466-4475
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612838163W00000X
OR044437163W00000X
CA14058363L00000X
OR27363L00000X
AZAP5989363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ423583Medicaid
AZZ144374OtherMEDICARE PTAN