Provider Demographics
NPI:1871595090
Name:STYTLE, TRICIA (DO)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:STYTLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14960 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7814
Mailing Address - Country:US
Mailing Address - Phone:623-594-3171
Mailing Address - Fax:623-594-3161
Practice Address - Street 1:14960 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 340
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7814
Practice Address - Country:US
Practice Address - Phone:623-594-3171
Practice Address - Fax:623-594-3161
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72942Medicare ID - Type Unspecified
AZH07821Medicare UPIN