Individual
TINA FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1360 N RIM DR, FLAGSTAFF, AZ 86001-3111
(928) 774-8000
(928) 774-0372
Mailing address
1360 N RIM DR, FLAGSTAFF, AZ 86001-3111
(928) 773-0003
(928) 773-1170
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
354619-4405
UT
363L00000X
Nurse Practitioner
Primary
AP8563
AZ
363LA2100X
Acute Care Nurse Practitioner
Primary
AP8563
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176578
—
AZ
01
—
AP8563
ARIZONA LICENSE
AZ
Enumeration date
07/15/2015
Last updated
04/19/2026
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