Provider Demographics
NPI:1932130887
Name:CHAFETZ, DANIEL P (NP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:CHAFETZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5309
Mailing Address - Country:US
Mailing Address - Phone:520-771-6782
Mailing Address - Fax:520-230-8126
Practice Address - Street 1:2819 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5309
Practice Address - Country:US
Practice Address - Phone:520-771-6782
Practice Address - Fax:520-230-8126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103631363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ834384Medicaid
AZQ28611Medicare UPIN
AZ101264Medicare PIN