Provider Demographics
NPI:1851612816
Name:DESERT BLOOM FAMILY PRACTICE
Entity Type:Organization
Organization Name:DESERT BLOOM FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STROCSHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-261-1925
Mailing Address - Street 1:1925 W ORANGE GROVE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1151
Mailing Address - Country:US
Mailing Address - Phone:520-261-1925
Mailing Address - Fax:480-393-4402
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1151
Practice Address - Country:US
Practice Address - Phone:520-261-1925
Practice Address - Fax:480-393-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty