Healthcare Provider Details

I. General information

NPI: 1073712717
Provider Name (Legal Business Name): NICOLE CATHERINE HOXWORTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 E VIA LINDA SUITE 150
SCOTTSDALE AZ
85258-5422
US

IV. Provider business mailing address

9060 E VIA LINDA SUITE 150
SCOTTSDALE AZ
85258-5422
US

V. Phone/Fax

Practice location:
  • Phone: 480-275-4196
  • Fax: 480-772-4296
Mailing address:
  • Phone: 480-275-4196
  • Fax: 480-772-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number43375
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME 102250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: