Provider Demographics
NPI:1417443995
Name:SMITH, DUSTIN ANDREW (FNP-C)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4322
Mailing Address - Country:US
Mailing Address - Phone:520-886-5315
Mailing Address - Fax:877-209-7377
Practice Address - Street 1:5902 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4322
Practice Address - Country:US
Practice Address - Phone:520-886-5315
Practice Address - Fax:877-209-7377
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily