Provider Demographics
NPI:1184018152
Name:ZOOK, TIFFANY ANNE CRAWFORD (CPNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE CRAWFORD
Last Name:ZOOK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 E CHAUNCEY LN STE 225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3117
Mailing Address - Country:US
Mailing Address - Phone:480-585-5200
Mailing Address - Fax:485-855-2333
Practice Address - Street 1:1120 S DOBSON RD
Practice Address - Street 2:SUITE 125
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-585-5200
Practice Address - Fax:480-585-5233
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7699363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0022494Medicaid