1184018152 NPI number — TIFFANY ANNE CRAWFORD ZOOK CPNP

Table of content: LISA CHRISTINE GERTRIDGE FNP-BC (NPI 1245968668)

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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