Healthcare Provider Details

I. General information

NPI: 1336074467
Provider Name (Legal Business Name): SCOCCOLO FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 105
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

1887 WHITNEY MESA DR # 4022
HENDERSON NV
89014-2069
US

V. Phone/Fax

Practice location:
  • Phone: 702-823-4300
  • Fax:
Mailing address:
  • Phone: 702-823-4300
  • Fax: 702-906-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY THOMAS SCOCCOLO
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 702-823-4300