Individual
LANA ELIZABETH FORMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4582 N 1ST AVE STE 170, TUCSON, AZ 85718-8607
(520) 829-6776
(520) 829-6661
Mailing address
4881 E GRANT RD, TUCSON, AZ 85712-2704
(520) 829-6776
(520) 829-6661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8307
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2020
Last updated
09/26/2024
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