Provider Demographics
NPI:1891829909
Name:HOOGEWERF, LYNAIA (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNAIA
Middle Name:
Last Name:HOOGEWERF
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 1:8380 W EMILE ZOLA AVE UNIT 5118
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-2006
Mailing Address - Country:US
Mailing Address - Phone:602-529-4800
Mailing Address - Fax:602-529-4799
Practice Address - Street 1:5233 E SOUTHERN AVE STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3628
Practice Address - Country:US
Practice Address - Phone:480-567-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ985912Medicaid
AZZ173559OtherMEDICARE PTAN