MEDICARE: JOAN ELIZABETH FORD CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	78144	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78144	OTHER	AL	PEDIATRIC NURSING CERTIFICATION BOARD

General Provider Information

NPI Number	:	1457683831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ELIZABETH FORD CPNP-PC

Provider Business Mailing Address
First Line	:	2611 WOODLEY PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-3834
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:	334-281-7453

Provider Business Practice Location Address
First Line	:	2611 WOODLEY PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-3834
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:	334-281-7453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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