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NPI Code Detail

MEDICARE: NATHAN TIRRELL PA-C

MEDICARE: NATHAN TIRRELL PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1780358440
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN TIRRELL PA-C
Provider Business Mailing Address
First Line : 13995 W STATLER BLVD STE 200
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-5503
Country : US
Telephone Number : 623-478-3100
Fax Number :
Provider Business Practice Location Address
First Line : 13995 W STATLER BLVD STE 200
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-5503
Country : US
Telephone Number : 623-478-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2021
Last Update Date : 07/19/2022

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Directions to “ NATHAN TIRRELL PA-C” Practice Location

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