Healthcare Provider Details

I. General information

NPI: 1225435514
Provider Name (Legal Business Name): SCOTT AWALD AGACNP-BC, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1876 E SABIN DR BLDG A
CASA GRANDE AZ
85122-6197
US

IV. Provider business mailing address

1876 E SABIN DR BLDG A
CASA GRANDE AZ
85122-6197
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-2536
  • Fax: 520-876-5794
Mailing address:
  • Phone: 520-836-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN139438
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP11212
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11212
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: