Provider Demographics
NPI:1174059968
Name:GULOTTA, CRYSTAL (DNP, CNM, FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:DNP, CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 E KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2147
Mailing Address - Country:US
Mailing Address - Phone:520-471-4856
Mailing Address - Fax:520-326-0302
Practice Address - Street 1:5245 E KNIGHT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2147
Practice Address - Country:US
Practice Address - Phone:520-471-4856
Practice Address - Fax:520-326-0302
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223799363LF0000X
AZAP9810367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ507765Medicaid