Healthcare Provider Details

I. General information

NPI: 1053930925
Provider Name (Legal Business Name): JESSICA COTTRELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34525 N SCOTTSDALE RD
SCOTTSDALE AZ
85266-1287
US

IV. Provider business mailing address

4400 N 32ND ST STE 110
PHOENIX AZ
85018-3961
US

V. Phone/Fax

Practice location:
  • Phone: 808-827-5504
  • Fax: 805-753-0764
Mailing address:
  • Phone: 602-956-9595
  • Fax: 602-956-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8475
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: