Provider Demographics
NPI:1760187868
Name:SMITH, MARCOS (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 E PALM TREE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-7421
Mailing Address - Country:US
Mailing Address - Phone:520-885-5400
Mailing Address - Fax:
Practice Address - Street 1:9580 E PALM TREE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-7421
Practice Address - Country:US
Practice Address - Phone:520-885-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ289898363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care