Provider Demographics
NPI:1518359520
Name:COUCHOUD, MIKI (FNP-C)
Entity type:Individual
Prefix:
First Name:MIKI
Middle Name:
Last Name:COUCHOUD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ELGIN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:AZ
Mailing Address - Zip Code:85611-7300
Mailing Address - Country:US
Mailing Address - Phone:520-249-3348
Mailing Address - Fax:520-455-5767
Practice Address - Street 1:6895 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0831
Practice Address - Country:US
Practice Address - Phone:520-615-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily