Provider Demographics
NPI:1902276124
Name:MONTANO, GINA (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:RENEE
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 E CROYDON PARK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5792
Mailing Address - Country:US
Mailing Address - Phone:520-696-3438
Mailing Address - Fax:
Practice Address - Street 1:50 E CROYDON PARK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5792
Practice Address - Country:US
Practice Address - Phone:520-696-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8019363L00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology