Provider Demographics
NPI:1487930871
Name:TJALAS, KIRK (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:TJALAS
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:KIRK
Other - Middle Name:ALAN
Other - Last Name:TJALAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC,PMHNP
Mailing Address - Street 1:7620 N HARTMAN LN STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7485
Mailing Address - Country:US
Mailing Address - Phone:520-345-0443
Mailing Address - Fax:866-531-9664
Practice Address - Street 1:7620 N HARTMAN LN STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7485
Practice Address - Country:US
Practice Address - Phone:520-689-6814
Practice Address - Fax:866-740-4777
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ234051363LP0808X, 363LF0000X
OR10028304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ615761900OtherDEEOIC HOME HEALTH CARE PROVIDER