Healthcare Provider Details

I. General information

NPI: 1093654824
Provider Name (Legal Business Name): MARIE HORTENSE TIOKOU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 S 21ST DR
PHOENIX AZ
85041-6561
US

IV. Provider business mailing address

4613 E SUMMERHAVEN DR
PHOENIX AZ
85044-4843
US

V. Phone/Fax

Practice location:
  • Phone: 480-284-9638
  • Fax: 602-429-8148
Mailing address:
  • Phone: 480-284-9638
  • Fax: 602-429-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number336636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: