Active NPI
Mary Jo Gagan, ANP
- Adult Health Nurse Practitioner
- Tucson, AZ
National Provider Identifier
1831170364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- RN093619
- Practice address
- 1775 E Skyline Dr
Ste 101
Tucson, AZ 85718-1162 - Phone
- (520) 615-6200
- Fax
- (520) 615-6255
- NPI assigned
- Nov 10, 2005
- Last updated
- Jul 13, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | RN093619 | AZ | Primary |
Addresses
Primary practice location
1775 E Skyline Dr
Ste 101
Tucson, AZ 85718-1162
Mailing address
1775 E Skyline Dr
Ste 101
Tucson, AZ 85718-1162
Phone (520) 615-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 918021 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN093619 | AZ | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1831170364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1775 E SKYLINE DR",
"address_2": "STE 101",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857181162",
"telephone_number": "520-615-6200",
"fax_number": "520-615-6255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 E SKYLINE DR",
"address_2": "STE 101",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857181162",
"telephone_number": "520-615-6200",
"fax_number": "520-615-6255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAGAN",
"first_name": "MARY",
"middle_name": "JO",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-10",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "AZ",
"license": "RN093619",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "918021",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.