Provider Demographics
NPI:1114483401
Name:TATE, VICKI (FNP-C)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20401 N 73RD ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4149
Mailing Address - Country:US
Mailing Address - Phone:480-237-5727
Mailing Address - Fax:
Practice Address - Street 1:20401 N 73RD ST STE 160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4149
Practice Address - Country:US
Practice Address - Phone:480-237-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140943163W00000X
AZ241362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse