Provider Demographics
NPI:1760069686
Name:BOLLARD, THEODORE J (ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:BOLLARD
Suffix:
Gender:M
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAGEE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6438
Mailing Address - Country:US
Mailing Address - Phone:520-638-5553
Mailing Address - Fax:
Practice Address - Street 1:400 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6438
Practice Address - Country:US
Practice Address - Phone:520-638-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily