Provider Demographics
NPI:1164154589
Name:TAGGART, SOPHIA LOREN (NP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LOREN
Last Name:TAGGART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 N 92ND ST UNIT 2030
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6109
Mailing Address - Country:US
Mailing Address - Phone:928-301-4583
Mailing Address - Fax:
Practice Address - Street 1:1580 N FIESTA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1032
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ276693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily