Provider Demographics
NPI:1215553938
Name:GORDON, LIA KAY (FNP)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:KAY
Last Name:GORDON
Suffix:
Gender:
Credentials:FNP
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 81064
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44181-0064
Mailing Address - Country:US
Mailing Address - Phone:520-795-8080
Mailing Address - Fax:520-323-6237
Practice Address - Street 1:2300 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2139
Practice Address - Country:US
Practice Address - Phone:520-881-1977
Practice Address - Fax:520-881-1979
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017142363LF0000X
AZ242014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily