Provider Demographics
NPI:1255761235
Name:STULTS, ANDREA (BSN, MSN, NP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STULTS
Suffix:
Gender:F
Credentials:BSN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 E INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:937-304-6829
Mailing Address - Fax:602-294-2385
Practice Address - Street 1:1250 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-1697
Practice Address - Country:US
Practice Address - Phone:937-304-6829
Practice Address - Fax:602-294-2385
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5275363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily