NPIMap

Individual provider Active NPI

Colleen Mary Ellis, FNP-C

  • Family Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1568053676
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
253304 Issued in AZ
Practice address
3662 W Ina Rd Ste 150
Tucson, AZ 85741-2269
Phone
(520) 912-4242
NPI assigned
Feb 1, 2021
Last updated
Feb 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 253304 AZ Primary

Addresses

Primary practice location

3662 W Ina Rd Ste 150
Tucson, AZ 85741-2269

Mailing address

7626 E Majestic Palm LN
Tucson, AZ 85756-6112
Phone (518) 651-7317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210222002551 AZ Practitioner - Nurse Practitioner 2567877780 Reassigns benefits to 1 organization
I20250402002063 TX Practitioner - Nurse Practitioner 2567877780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3900 Ambassador Dr
Anchorage, AK 99508-5922
Phone (907) 563-2662

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Arizona Urgent Care LLC CurrentSince Feb 1, 2021 Accepting new patients
Southern Arizona Urgent Care, LLC CurrentSince Feb 1, 2021 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Jan 2, 2025 Accepting new patients
Alaska Native Tribal Health Consortium PastSince Jan 2, 2025 Accepting new patients

Locations

3900 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1128

4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

1040 S Harrison Rd
Ste 120
Tucson, AZ 85748
Phone (520) 777-7025

3662 W Ina Rd
Ste 150
Tucson, AZ 85741
Phone (520) 900-7020

6572 E Grant Rd
Ste 130
Tucson, AZ 85715
Phone (520) 300-4249

7725 N Oracle Rd
Ste 131
Tucson, AZ 85704
Phone (520) 544-2273

90 W River Rd
Tucson, AZ 85704
Phone (520) 912-4200

Interoperability endpoints

  • Direct secure messaging: colleen.ellis.1@15729.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1568053676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7626 E MAJESTIC PALM LN",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857566112",
            "telephone_number": "518-651-7317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3662 W INA RD STE 150",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857412269",
            "telephone_number": "520-912-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "COLLEEN",
        "middle_name": "MARY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "253304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.