Provider Demographics
NPI:1992888952
Name:SAFRONOV, YURIY (FNP)
Entity type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:SAFRONOV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 E PARADISE FALLS DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6687
Mailing Address - Country:US
Mailing Address - Phone:520-615-6200
Mailing Address - Fax:520-615-6255
Practice Address - Street 1:3945 E PARADISE FALLS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6687
Practice Address - Country:US
Practice Address - Phone:520-615-6200
Practice Address - Fax:520-615-6255
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN121756363LF0000X
AZAP2497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152267Medicaid
AZ152267Medicaid