Provider Demographics
NPI:1972111607
Name:GLEASON, REBECCA (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
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 1:3720 S PARK AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5046
Mailing Address - Country:US
Mailing Address - Phone:520-485-3200
Mailing Address - Fax:
Practice Address - Street 1:3720 S PARK AVE STE 601
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5046
Practice Address - Country:US
Practice Address - Phone:520-485-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2022-03-07
Deactivation Date:2022-02-15
Deactivation Code:
Reactivation Date:2022-03-06
Provider Licenses
StateLicense IDTaxonomies
AZRN212170163W00000X
AZ270379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse