SHANTEL TANAE GLICK (NPI# 1841342631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841342631 |
| Entity Type | Individual |
| Full Name | SHANTEL TANAE GLICK |
| Credential | PA-C |
| Practice Address |
21681 N 77th Ave Peoria AZ 85382-2132 |
| Practice Telephone | 6239729200 |
| Practice Fax Number | 6239729209 |
| Mailing Telephone | 6239729200 |
| Mailing Fax Number | 6239729209 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-05-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | AZ3142 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 920513 | 05 | |
| MEDICARE PTAN | Z159355 | 01 |
| Street Address |
21681 N 77TH AVE |
| City | PEORIA |
| State | AZ |
| Zip Code | 85382-2132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215928254 | Nimisha Darshak Shah | Family Medicine | 21681 N 77th Ave, Ste. 1410, Peoria, AZ 85382-2132 | 2005-10-31 |
| 1174869721 | Honorhealth Medical Group, LLC | Family Medicine | 21681 N 77th Ave, Suite 1405, Peoria, AZ 85382-2132 | 2012-12-28 |
| 1659694156 | Aspen Rae LLC | Family Medicine | 21681 N 77th Ave, Suite 1415, Peoria, AZ 85382-2132 | 2010-03-11 |
| 1659598258 | Valerie I. Bustos | Family Medicine | 21681 N 77th Ave, Suite 1410, Peoria, AZ 85382-2132 | 2007-04-18 |
| 1740366293 | Douglas R Gabriel | Dentist | 21681 N 77th Ave, Ste. 1420, Peoria, AZ 85382-2132 | 2006-10-27 |
| 1912933227 | Shane A Mccall | Chiropractor | 21681 N 77th Ave, Suite 1415, Peoria, AZ 85382-2132 | 2006-06-26 |
| 1336119973 | Matthew R Anderson | Family Medicine | 21681 N 77th Ave, Suite 1405, Peoria, AZ 85382-2132 | 2006-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435146 | Arizona Ot Solutions LLC | Occupational Therapist | 7450 W. Karen Lee Lane, Peoria, AZ 85382 | 2020-10-21 |
| 1497380604 | Idream Psychiatry | Psychiatry & Neurology | 8194 West Deer Valley Rd, 106-516, Peoria, AZ 85382 | 2020-03-08 |
| 1770137648 | Stefan Cseh | Occupational Therapy Assistant | 8765 W Keiton Lane #116, Peona, AZ 85382 | 2019-07-30 |
| 1174177422 | Assyrian Cultural Foundation of Arizona | Homemaker | 9163 West Union Hills Drive, Suite 114 and 115, Peoria, AZ 85382 | 2019-07-25 |
| 1073072765 | Darby Shipman | Physical Therapist | 8685 W. Union Hills Drive, Peoria, AZ 85382 | 2019-03-13 |
| 1811483480 | Kimberly Ann Cochran | Nurse Practitioner | 8194 W Deer Valley Rd Ste 106-516, Peoria, AZ 85382 | 2018-07-07 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1497258727 | Nkemdirim Obiora | Nurse Practitioner | 7853 West Lone Cactus Drive, Peoria, AZ 85382 | 2018-03-13 |
| 1851893721 | Alyssa Michelle Bauman | Registered Nurse | 20283 N Lake Pleasant Rd Ste 112, Peoria, AZ 85382 | 2018-03-06 |
| 1043767106 | Jason Mcaddley | Pharmacist | 9425 West Union Hills Drive, Peoria, AZ 85382 | 2016-09-07 |
| Find all providers in zip 85382 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275148280 | Patricia Miriam Rus | Physician Assistant | 23615 N 105th Dr, Peoria, AZ 85383-1195 | 2020-09-15 |
| 1083235154 | Katlyn Coyer | Physician Assistant | 900 Main St Ste 530, Peoria, IL 61602-1005 | 2020-04-30 |
| 1114586690 | Courtney A Hitpas | Physician Assistant | 3120 N Bigelow St, Peoria, IL 61604-1628 | 2019-06-10 |
| 1689137671 | Jeffrey Benjamin Miessau | Physician Assistant | 7707 N Knoxville Ave Ste 200, Peoria, IL 61614-2020 | 2019-04-08 |
| 1417413337 | Michelle Nemeh | Physician Assistant | 6760 W Thunderbird Rd Ste 100, Peoria, AZ 85381-5048 | 2019-02-15 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1962977538 | Ashley Deyoung | Physician Assistant | 13943 N 91st Ave Ste F101, Peoria, AZ 85381-3689 | 2018-10-09 |
| 1326557141 | Melissa L. Kingston | Physician Assistant | 13760 N 93rd Ave Ste 201, Peoria, AZ 85381-4200 | 2017-09-25 |
| 1396196465 | Ayla Diamond | Physician Assistant | 9165 W Thunderbird Rd Ste 200, Peoria, AZ 85381-4847 | 2016-06-29 |
| 1336530948 | Carolina C. Castro | Physician Assistant | 13128 N. 94th Drive, Suite 100, Peoria, AZ 85381-4252 | 2015-02-18 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.