MEDICARE: MARIE HORTENSE TIOKOU PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	336636	AZ

General Provider Information

NPI Number	:	1093654824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE HORTENSE TIOKOU PMHNP

Provider Business Mailing Address
First Line	:	4613 E SUMMERHAVEN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4843
Country	:	US
Telephone Number	:	480-284-9638
Fax Number	:	602-429-8148

Provider Business Practice Location Address
First Line	:	6812 S 21ST DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6561
Country	:	US
Telephone Number	:	480-284-9638
Fax Number	:	602-429-8148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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