Provider Demographics
NPI:1154432086
Name:HEATH, IDA (NP)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:HEATH
Suffix:
Gender:
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:PO BOX 91486
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-1486
Mailing Address - Country:US
Mailing Address - Phone:520-682-0291
Mailing Address - Fax:
Practice Address - Street 1:5390 E ERICKSON DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2822
Practice Address - Country:US
Practice Address - Phone:520-733-2250
Practice Address - Fax:520-733-2270
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086039163W00000X
AZAP5832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ72504Medicare UPIN