Provider Demographics
NPI:1073119442
Name:TATRO, CODDIE L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CODDIE
Middle Name:L
Last Name:TATRO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CODDIE
Other - Middle Name:L
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17729 W RED BIRD RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1033
Mailing Address - Country:US
Mailing Address - Phone:480-343-0481
Mailing Address - Fax:
Practice Address - Street 1:7975 N HAYDEN RD STE D354
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3243
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily