Provider Demographics
NPI:1265402358
Name:AGINS, JODY F (FNP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:F
Last Name:AGINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:FRAME
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8300 N WESTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1043
Mailing Address - Country:US
Mailing Address - Phone:520-981-0216
Mailing Address - Fax:520-344-9226
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-722-2400
Practice Address - Fax:520-323-7531
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN135991363LF0000X, 363LG0600X
AZRN134991363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ998594Medicaid
AZMF1193488OtherDEA LICENSE
AZ107888Medicare ID - Type Unspecified
AZ998594Medicaid