MEDICARE: ZACHARY TIMOTHY SCOTT BRAGG

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	363LP2300X	Primary Care Nurse Practitioner	275885	AZ

General Provider Information

NPI Number	:	1962374405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY TIMOTHY SCOTT BRAGG

Provider Business Mailing Address
First Line	:	100 E CAMELBACK RD STE 108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1061
Country	:	US
Telephone Number	:	602-354-3925
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E CAMELBACK RD STE 108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1061
Country	:	US
Telephone Number	:	602-354-3925
Fax Number	:

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

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/23/2025

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