Provider Demographics
NPI:1134613938
Name:CAMBERN, MICHELLE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:CAMBERN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:POPOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16053 W WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7603
Mailing Address - Country:US
Mailing Address - Phone:602-430-0425
Mailing Address - Fax:
Practice Address - Street 1:350 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2602
Practice Address - Country:US
Practice Address - Phone:520-873-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCAPN0101820CNP363LF0000X
FLAPRN11033277363LF0000X
UT14039411-4405363LF0000X
AZ219809363L00000X
AZRN098743163WE0003X
WAAP61581069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency