Provider Demographics
NPI:1700842630
Name:COLUSSY, ANDREA MARIA (NP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIA
Last Name:COLUSSY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6627
Mailing Address - Country:US
Mailing Address - Phone:520-297-8429
Mailing Address - Fax:520-989-3486
Practice Address - Street 1:2001 W ORANGE GROVE RD STE 312
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1141
Practice Address - Country:US
Practice Address - Phone:520-297-8429
Practice Address - Fax:520-989-3486
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN035844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ463076OtherAHCCCS
AZWA536164213OtherRAILROAD MEDICARE
AZZ21380Medicare ID - Type Unspecified
AZ463076OtherAHCCCS