Provider Demographics
NPI:1477554202
Name:CLICK, PHYLLIS ELAINE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ELAINE
Last Name:CLICK
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 1:7014 E GOLF LINKS RD # 137
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1064
Mailing Address - Country:US
Mailing Address - Phone:520-349-7275
Mailing Address - Fax:
Practice Address - Street 1:1921 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7806
Practice Address - Country:US
Practice Address - Phone:520-544-5210
Practice Address - Fax:520-544-5535
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN053082208100000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ575954Medicaid
AZP24781Medicare UPIN
AZ64401Medicare ID - Type Unspecified