Provider Demographics
NPI:1023582376
Name:CONSOLACION, MANNIX ISAIAS (FNP)
Entity type:Individual
Prefix:MR
First Name:MANNIX
Middle Name:ISAIAS
Last Name:CONSOLACION
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 N ALVERNON WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1804
Mailing Address - Country:US
Mailing Address - Phone:520-382-3330
Mailing Address - Fax:520-618-0280
Practice Address - Street 1:5475 S BRAIDED WASH DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-6094
Practice Address - Country:US
Practice Address - Phone:520-576-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily