Provider Demographics
NPI:1669111548
Name:ACKERMAN, TATE (CPO)
Entity type:Individual
Prefix:
First Name:TATE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 W MEEKER BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4431
Mailing Address - Country:US
Mailing Address - Phone:623-474-3099
Mailing Address - Fax:623-474-3119
Practice Address - Street 1:13925 W MEEKER BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4431
Practice Address - Country:US
Practice Address - Phone:623-474-3099
Practice Address - Fax:623-474-3119
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCPO03616224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist