Provider Demographics
NPI:1457342214
Name:ALCOCK, NAOMI (PA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:ALCOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N 24TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6536
Mailing Address - Country:US
Mailing Address - Phone:602-840-0681
Mailing Address - Fax:602-957-1570
Practice Address - Street 1:3700 N 24TH ST STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6536
Practice Address - Country:US
Practice Address - Phone:602-840-0681
Practice Address - Fax:602-957-1570
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5068363A00000X, 363A00000X
NJ25MP00283500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSF7991Medicare ID - Type Unspecified
P88457Medicare UPIN