Provider Demographics
NPI:1770705196
Name:MAZZACANO, PAULA LYNN (NP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:MAZZACANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:LYNN
Other - Last Name:HEIDRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4519 E CHISUM TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8568
Mailing Address - Country:US
Mailing Address - Phone:480-585-0674
Mailing Address - Fax:
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:480-425-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN027760363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health