Individual
NITA KOFCHOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2802 E DISTRICT ST, TUCSON, AZ 85714-2081
(520) 301-2400
Mailing address
202 E EARLL DR STE 200, PHOENIX, AZ 85012-2647
(602) 808-2800
(602) 808-2799
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
201710096NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60291694
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP8509
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
094362
—
AZ
01
—
AP60291694
WASHINGTON STATE LICENSE
WA
Enumeration date
11/20/2009
Last updated
06/01/2021
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