Healthcare Provider Details

I. General information

NPI: 1255102513
Provider Name (Legal Business Name): JOAN M DIGEORGE RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 PHILLIPS FIELD RD
FAIRBANKS AK
99709-3933
US

IV. Provider business mailing address

2555 PHILLIPS FIELD RD
FAIRBANKS AK
99709-3933
US

V. Phone/Fax

Practice location:
  • Phone: 907-268-2737
  • Fax:
Mailing address:
  • Phone: 907-268-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217424
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163313
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: