Provider Demographics
NPI:1699046854
Name:PRAZAK, MATTHEW (NP-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:PRAZAK
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:PRAZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:25500 N NORTERRA DR # B-3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25500 N NORTERRA DR # B-3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8200
Practice Address - Country:US
Practice Address - Phone:623-277-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710517363LF0000X
TN16428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily