Provider Demographics
NPI:1013421148
Name:LOYA JAFFE, CASTILLANNA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASTILLANNA
Middle Name:NICOLE
Last Name:LOYA JAFFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASTILLANNA
Other - Middle Name:NICOLE
Other - Last Name:LOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:602-865-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1146939OtherNCCPA
AZ6923OtherPA STATE OF AZ