1184018152 NPI number — TIFFANY ANNE CRAWFORD ZOOK CPNP

Table of content: TIFFANY ANNE CRAWFORD ZOOK CPNP (NPI 1184018152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184018152 NPI number — TIFFANY ANNE CRAWFORD ZOOK CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOOK
Provider First Name:
TIFFANY
Provider Middle Name:
ANNE CRAWFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184018152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7010 E CHAUNCEY LN STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85054-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-585-5200
Provider Business Mailing Address Fax Number:
485-855-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 S DOBSON RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-585-5200
Provider Business Practice Location Address Fax Number:
480-585-5233
Provider Enumeration Date:
03/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  AP7699 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0022494 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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