Provider Demographics
NPI:1104061589
Name:SCOTT, AUDREY SHERON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SHERON
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 MEYER PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2967
Mailing Address - Country:US
Mailing Address - Phone:949-515-6725
Mailing Address - Fax:949-515-6726
Practice Address - Street 1:2045 MEYER PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2967
Practice Address - Country:US
Practice Address - Phone:949-515-6725
Practice Address - Fax:949-515-6726
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423748364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health