Provider Demographics
NPI:1821243692
Name:TAVANI, ROBERT DANIEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:TAVANI
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 1:3707 N 7TH ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5059
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:3707 N 7TH ST
Practice Address - Street 2:STE. 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5059
Practice Address - Country:US
Practice Address - Phone:602-264-9100
Practice Address - Fax:602-264-9101
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3210363LF0000X
NM75731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner