Provider Demographics
NPI:1790204600
Name:GEBRESENBET, TIRSIT (NP-C)
Entity Type:Individual
Prefix:
First Name:TIRSIT
Middle Name:
Last Name:GEBRESENBET
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9843 W KEYSER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2913
Mailing Address - Country:US
Mailing Address - Phone:602-373-5555
Mailing Address - Fax:
Practice Address - Street 1:651 W COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-248-0550
Practice Address - Fax:602-248-0557
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10518363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care