Provider Demographics
NPI:1679773444
Name:DAKSLA, NIDA GARCIA (ANP)
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:GARCIA
Last Name:DAKSLA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1819
Mailing Address - Country:US
Mailing Address - Phone:520-468-5593
Mailing Address - Fax:520-468-5593
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-468-5593
Practice Address - Fax:520-468-5593
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4227363LA2200X
MI4704236232363LA2200X
CA17071363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health