Provider Demographics
NPI:1962374405
Name:BRAGG, ZACHARY TIMOTHY SCOTT
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TIMOTHY SCOTT
Last Name:BRAGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CAMELBACK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1061
Mailing Address - Country:US
Mailing Address - Phone:602-354-3925
Mailing Address - Fax:
Practice Address - Street 1:100 E CAMELBACK RD STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1061
Practice Address - Country:US
Practice Address - Phone:602-354-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275885363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care