Provider Demographics
NPI:1447387139
Name:TACKETT, SHERRY C (NP)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:C
Last Name:TACKETT
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 1:2236 E LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1143
Mailing Address - Country:US
Mailing Address - Phone:602-432-2026
Mailing Address - Fax:
Practice Address - Street 1:10617 N HAYDEN RD
Practice Address - Street 2:SUITE B-102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5578
Practice Address - Country:US
Practice Address - Phone:480-483-9011
Practice Address - Fax:480-483-9011
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN052122363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health