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General NPI Number Information
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NPI Number | 1720280795
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Entity Type | Organization
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Legal Business Name | MARICOPA SURGICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8314 N 49TH DR
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City | GLENDALE
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State | AZ
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Zip | 85302-6307
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Country | US
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Telephone | 602-616-0123
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Fax | 623-847-1140
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Provider Business Mailing Address
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Address Line | 8314 N 49TH DR
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City | GLENDALE
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State | AZ
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Zip | 85302-6307
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Country | US
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Telephone | 602-616-0123
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Fax | 623-847-1140
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANN ELIZABETH TYRRELL
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Credential | NP
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Telephone | 602-616-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN043432
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License Number State | AZ
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