Healthcare Provider Details

I. General information

NPI: 1457725640
Provider Name (Legal Business Name): CORIANNA JUDD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORIANNA BREVER

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5452
US

IV. Provider business mailing address

1760 E RIVER RD STE 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6280
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number6280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: