Provider Demographics
NPI:1851615710
Name:INDEPENDENT FIRST ASSIST INC.
Entity Type:Organization
Organization Name:INDEPENDENT FIRST ASSIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC, CRNFA
Authorized Official - Phone:520-444-8940
Mailing Address - Street 1:PO BOX 32500
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2500
Mailing Address - Country:US
Mailing Address - Phone:520-444-8940
Mailing Address - Fax:520-760-6690
Practice Address - Street 1:10129 E RIO DE ORO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8117
Practice Address - Country:US
Practice Address - Phone:520-444-8940
Practice Address - Fax:520-760-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-075070363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ918849OtherAHCCCS