Provider Demographics
NPI:1104177096
Name:REA, ROXANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S KINGS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-7352
Mailing Address - Country:US
Mailing Address - Phone:480-981-3000
Mailing Address - Fax:480-654-5761
Practice Address - Street 1:6410 S KINGS RANCH RD
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-7352
Practice Address - Country:US
Practice Address - Phone:480-981-3000
Practice Address - Fax:480-654-5761
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5184363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical