Provider Demographics
NPI:1366790263
Name:PITTS, TRICIA D (RN)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:D
Last Name:PITTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 W CREEDANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3920
Mailing Address - Country:US
Mailing Address - Phone:623-252-7643
Mailing Address - Fax:
Practice Address - Street 1:804 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3603
Practice Address - Country:US
Practice Address - Phone:602-257-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN151613163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool