Provider Demographics
NPI:1750822839
Name:ROGERS, JOHN-MARK (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN-MARK
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10929 E OAK GROVE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9525
Mailing Address - Country:US
Mailing Address - Phone:520-891-6010
Mailing Address - Fax:
Practice Address - Street 1:10929 E OAK GROVE PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9525
Practice Address - Country:US
Practice Address - Phone:520-891-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily