MEDICARE: MRS. JANELLE TIANNA HOPPES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2890	AZ
2	363A00000X	Physician Assistant	2890	AZ

General Provider Information

NPI Number	:	1447274345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANELLE TIANNA HOPPES PA-C

Provider Business Mailing Address
First Line	:	1250 S CLEARVIEW AVE
Second Line	:	SUITE 100
City	:	MESA
State	:	AZ
Zip	:	85209-3378
Country	:	US
Telephone Number	:	480-207-2990
Fax Number	:	480-838-1541

Provider Business Practice Location Address
First Line	:	1955 W GUADALUPE RD
Second Line	:	SUITE 1 & 2
City	:	MESA
State	:	AZ
Zip	:	85202-7487
Country	:	US
Telephone Number	:	480-207-2990
Fax Number	:	480-838-1541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/12/2014

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