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General NPI Number Information
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NPI Number | 1174722888
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Entity Type | Individual
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Provider Name | SCOTT ALLAN JOLLIFFE CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 5430 DISTINCTION WAY
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City | PRESCOTT
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State | AZ
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Zip | 86301-8437
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Country | US
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Telephone | 928-445-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 1192 N RUSTY NAIL RD
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1478
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Country | US
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Telephone | 503-277-0265
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 200960029CRNA
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA1473
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License Number State | AZ
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