Provider Demographics
NPI:1386762953
Name:SYMOND, ANNA M (PA-C, LAC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:M
Last Name:SYMOND
Suffix:
Gender:F
Credentials:PA-C, LAC
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:COCILOVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, LAC
Mailing Address - Street 1:172 E MERRITT ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-445-0141
Mailing Address - Fax:928-445-9641
Practice Address - Street 1:172 E MERRITT ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-445-0141
Practice Address - Fax:928-445-9641
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0046171100000X
AZ1409363A00000X
AZ1049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist