Provider Demographics
NPI:1720725625
Name:ACACIA S HEALTHCARE PLLC
Entity Type:Organization
Organization Name:ACACIA S HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:D
Authorized Official - Last Name:TATE-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:609-364-4028
Mailing Address - Street 1:23864 N 166TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1460
Mailing Address - Country:US
Mailing Address - Phone:609-364-4028
Mailing Address - Fax:
Practice Address - Street 1:23864 N 166TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-1460
Practice Address - Country:US
Practice Address - Phone:609-364-4028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty