Provider Demographics
NPI:1063712537
Name:TWEEDY, VICTORIA ANN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ANN
Last Name:TWEEDY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 N 103RD AVE
Mailing Address - Street 2:STE H5
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3032
Mailing Address - Country:US
Mailing Address - Phone:623-777-4747
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE STE H5
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3032
Practice Address - Country:US
Practice Address - Phone:623-777-4747
Practice Address - Fax:623-334-4400
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ570267Medicaid
AZ2186676Medicare UPIN