Provider Demographics
NPI:1306892997
Name:SHARP, TIMOTHY BRIAN (PAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:SHARP
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3008
Mailing Address - Fax:602-406-6108
Practice Address - Street 1:1875 W FRYE RD STE 300
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6184
Practice Address - Country:US
Practice Address - Phone:480-917-5600
Practice Address - Fax:602-294-4497
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2179363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44123802Medicaid
AZ44123802Medicaid
AZ64872Medicare ID - Type Unspecified
AZ2179OtherLICENSE