Provider Demographics
NPI:1396791422
Name:HASTEN, ANNETTE L (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:L
Last Name:HASTEN
Suffix:
Gender:F
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 1:1900 W VALENCIA RD
Mailing Address - Street 2:MINUTE CLINIC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6628
Mailing Address - Country:US
Mailing Address - Phone:520-807-2288
Mailing Address - Fax:520-807-5361
Practice Address - Street 1:1900 W VALENCIA RD
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6628
Practice Address - Country:US
Practice Address - Phone:520-807-2288
Practice Address - Fax:520-807-5361
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086703363L00000X
AZRN086703/AP1839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ12169Medicare UPIN