Provider Demographics
NPI:1821374984
Name:ZIMMERMAN, LAURA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3549
Practice Address - Country:US
Practice Address - Phone:520-382-8200
Practice Address - Fax:520-297-3505
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4125363LF0000X
AZAP4215363L00000X
AZRN170718163WR0006X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ656649Medicaid
AZZ149931Medicare PIN