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4433 E Broadway Blvd Ste 101 Tucson AZ 85711-3536 | |
| (877) 465-6650 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4433 E Broadway Blvd Ste 101, Tucson, Arizona |
| Authorized Official Name and Position | Jason Herzog (CEO) |
| Authorized Official Contact | 8049555246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3540 Pump Rd # 1188 Richmond VA 23233-1115 Ph: (804) 404-6270 | 4433 E Broadway Blvd Ste 101 Tucson AZ 85711-3536 Ph: (877) 465-6650 |
| NPI Number | 1194414805 |
|---|---|
| Provider Enumeration Date | 05/08/2023 |
| Last Update Date | 11/24/2024 |
| Certification Date | 11/24/2024 |
| Medicare PECOS PAC ID | 1759742919 |
|---|---|
| Medicare Enrollment ID | O20230803002746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194414805 | NPI | - | NPPES |
| Provider Name | Tammy S Ziegler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558356766 PECOS PAC ID: 8325015050 Enrollment ID: I20040913001072 |
| Provider Name | Lori Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679939987 PECOS PAC ID: 0648579086 Enrollment ID: I20160505002037 |
| Provider Name | Rachel E Waltz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386071900 PECOS PAC ID: 4284924176 Enrollment ID: I20160606001247 |
| Provider Name | Sonia M Grace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457851628 PECOS PAC ID: 2668734013 Enrollment ID: I20180322001417 |
| Provider Name | Cameron Chappell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316571532 PECOS PAC ID: 0941639322 Enrollment ID: I20200406002690 |
| Provider Name | Amanda Slaten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245788363 PECOS PAC ID: 3971915851 Enrollment ID: I20201217001739 |
| Provider Name | Emily Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407438146 PECOS PAC ID: 6507275823 Enrollment ID: I20210517001483 |
| Provider Name | Jennifer Gregory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679148472 PECOS PAC ID: 4587062492 Enrollment ID: I20211007000504 |
| Provider Name | Heidi L Needler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912657289 PECOS PAC ID: 3971990888 Enrollment ID: I20220425000287 |
| Provider Name | Amber Jane Hill Garlick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235860412 PECOS PAC ID: 6204216724 Enrollment ID: I20220630000637 |
| Provider Name | Katie Jo Rood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215690623 PECOS PAC ID: 8325409709 Enrollment ID: I20230801004081 |
| Provider Name | Catherine Obaseki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205614054 PECOS PAC ID: 9638518897 Enrollment ID: I20240419003133 |
| Provider Name | Shannon Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902212608 PECOS PAC ID: 1456675693 Enrollment ID: I20240420000097 |
| Provider Name | Kimberly Koll |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336641679 PECOS PAC ID: 8325588403 Enrollment ID: I20240904004329 |
| Provider Name | Brian R Still |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245420314 PECOS PAC ID: 2567643901 Enrollment ID: I20240905004255 |
| Provider Name | Candice Dogans |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1699186189 PECOS PAC ID: 0446796502 Enrollment ID: I20240924000826 |
| Provider Name | Heidijo Elyea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013451509 PECOS PAC ID: 1759662463 Enrollment ID: I20240927000442 |
| Provider Name | Caitlin Hantelman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194573550 PECOS PAC ID: 2466983416 Enrollment ID: I20241002001125 |
| Provider Name | Vanessa Renee Smith Mccullough |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1205440112 PECOS PAC ID: 2567993199 Enrollment ID: I20241007001200 |
| Provider Name | Mallory Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245611847 PECOS PAC ID: 7214241751 Enrollment ID: I20241031000174 |
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