Provider Demographics
NPI:1780714477
Name:GORDON, RACHEL ELIZABETH (FNPC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:GORDON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2055 W HOSPITAL DR
Mailing Address - Street 2:SUITE 295
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7892
Mailing Address - Country:US
Mailing Address - Phone:520-326-1457
Mailing Address - Fax:520-326-1464
Practice Address - Street 1:2055 W HOSPITAL DR
Practice Address - Street 2:SUITE 295
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7892
Practice Address - Country:US
Practice Address - Phone:520-326-1457
Practice Address - Fax:520-326-1464
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ526013Medicaid
AZ881707Medicaid
AZZ137340Medicare UPIN
AZ526013Medicaid
AZZ131102Medicare UPIN