Provider Demographics
NPI:1831178912
Name:DEANDA, PAULA K (NP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:DEANDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W PASEO MONSERRAT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1329
Mailing Address - Country:US
Mailing Address - Phone:520-465-8373
Mailing Address - Fax:
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:602-462-1132
Practice Address - Fax:844-877-3840
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN100957363LA2100X
AZAP 1757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805468Medicaid
AZZ81004Medicare PIN
AZZ111157Medicare PIN
AZZ111158Medicare PIN
P97050Medicare UPIN