Provider Demographics
NPI:1134016132
Name:SCRUGHAM, ANDREA (EMT-P)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCRUGHAM
Suffix:
Gender:F
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 N DREY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4463
Mailing Address - Country:US
Mailing Address - Phone:602-908-7975
Mailing Address - Fax:
Practice Address - Street 1:10243 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1931
Practice Address - Country:US
Practice Address - Phone:602-908-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ92001688146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic