Provider Demographics
NPI:1720643737
Name:HUDA, TASNEEM UZMA
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:UZMA
Last Name:HUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4454
Mailing Address - Country:US
Mailing Address - Phone:602-584-5444
Mailing Address - Fax:602-584-6202
Practice Address - Street 1:9520 W PALM LN STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4454
Practice Address - Country:US
Practice Address - Phone:602-584-5444
Practice Address - Fax:602-584-6202
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47878363A00000X
AZ9167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid