Provider Demographics
NPI:1790743409
Name:FAVATA, NANCY J (PA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:FAVATA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:ARIZONA COMMUNITY PHYSICIANS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:5880 W LA CHOLLA BLVD
Practice Address - Street 2:#150 CASAS ADOBES FAMILY PRACTICE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-751-3602
Practice Address - Fax:520-547-5761
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
AZ2154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27366Medicare UPIN