Provider Demographics
NPI:1295453165
Name:MYERS, CHINE QUETZALCOATL TAN (FNP-C)
Entity type:Individual
Prefix:
First Name:CHINE
Middle Name:QUETZALCOATL TAN
Last Name:MYERS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10659 E ROSE HILL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5961
Mailing Address - Country:US
Mailing Address - Phone:520-247-0451
Mailing Address - Fax:
Practice Address - Street 1:335 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6406
Practice Address - Country:US
Practice Address - Phone:520-586-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06221757363LF0000X
AZ218258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily