Provider Demographics
NPI:1437161908
Name:HARTSFIELD-MOSHER, LAYLA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAYLA
Middle Name:ANN
Last Name:HARTSFIELD-MOSHER
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 1:9007 N 14TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2987
Mailing Address - Country:US
Mailing Address - Phone:602-770-9053
Mailing Address - Fax:
Practice Address - Street 1:7725 N 43RD AVE STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:623-931-9201
Practice Address - Fax:623-931-2116
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105931Medicare PIN