Provider Demographics
NPI:1740054469
Name:LOOMIS, RON E JR (APRN FNP-BC)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:E
Last Name:LOOMIS
Suffix:JR
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 W VIA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-4268
Mailing Address - Country:US
Mailing Address - Phone:602-616-5511
Mailing Address - Fax:
Practice Address - Street 1:14678 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2137
Practice Address - Country:US
Practice Address - Phone:623-933-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ300237363LF0000X
CA95027011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily