Provider Demographics
NPI:1972852846
Name:COTTON, DARYL IAN (MSN)
Entity Type:Individual
Prefix:MR
First Name:DARYL
Middle Name:IAN
Last Name:COTTON
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9525
Mailing Address - Country:US
Mailing Address - Phone:623-640-7682
Mailing Address - Fax:855-932-1312
Practice Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9525
Practice Address - Country:US
Practice Address - Phone:623-640-7682
Practice Address - Fax:855-932-1312
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN175196163W00000X
AZAP11560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse