Provider Demographics
NPI:1447274345
Name:HOPPES, JANELLE TIANNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:TIANNA
Last Name:HOPPES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JANELLE
Other - Middle Name:TIANNA
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1250 S CLEARVIEW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-207-2990
Mailing Address - Fax:480-838-1541
Practice Address - Street 1:1955 W GUADALUPE RD
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7487
Practice Address - Country:US
Practice Address - Phone:480-207-2990
Practice Address - Fax:480-838-1541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2890363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ72411Medicare UPIN
AZ11155YMedicare PIN