Provider Demographics
NPI:1013927607
Name:NICOLETTI, ROSANNA R (MD)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:R
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-885-3588
Mailing Address - Fax:520-290-3930
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 555
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-885-3588
Practice Address - Fax:520-290-3958
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ524508Medicaid
AZ524508Medicaid
AZZ138113Medicare PIN