Provider Demographics
NPI:1861512170
Name:BOYD, GENA PAT (RN)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:PAT
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-7745
Mailing Address - Country:US
Mailing Address - Phone:520-886-0472
Mailing Address - Fax:
Practice Address - Street 1:3951 S PANTANO RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-4014
Practice Address - Country:US
Practice Address - Phone:520-731-7517
Practice Address - Fax:520-731-7604
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN045304163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ574097Medicaid