Provider Demographics
NPI:1376078303
Name:FLAGSTAFF ADVANCED SURGICAL ASSISTANTS PLLC
Entity Type:Organization
Organization Name:FLAGSTAFF ADVANCED SURGICAL ASSISTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP-BC
Authorized Official - Phone:208-818-6181
Mailing Address - Street 1:9405 N BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1247
Mailing Address - Country:US
Mailing Address - Phone:208-818-6181
Mailing Address - Fax:928-255-0096
Practice Address - Street 1:9405 N BRYANT RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1247
Practice Address - Country:US
Practice Address - Phone:208-818-6181
Practice Address - Fax:928-255-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8631363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty