Healthcare Provider Details

I. General information

NPI: 1174722888
Provider Name (Legal Business Name): SCOTT ALLAN JOLLIFFE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 09/29/2026
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 DISTINCTION WAY
PRESCOTT AZ
86301-8437
US

IV. Provider business mailing address

1192 N RUSTY NAIL RD
PRESCOTT VALLEY AZ
86314-1478
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-1919
  • Fax:
Mailing address:
  • Phone: 503-277-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200960029CRNA
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1473
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: