Provider Demographics
NPI:1215556188
Name:FOXWORTHY, TAYLOR CAMILLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CAMILLE
Last Name:FOXWORTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5615
Mailing Address - Country:US
Mailing Address - Phone:520-577-3333
Mailing Address - Fax:520-577-4685
Practice Address - Street 1:4930 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5615
Practice Address - Country:US
Practice Address - Phone:520-577-3333
Practice Address - Fax:520-577-4685
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084746Medicaid