Healthcare Provider Details

I. General information

NPI: 1306084264
Provider Name (Legal Business Name): JOCELYN CORDERO RAMOS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR STE 105
APACHE JUNCTION AZ
85220-3830
US

IV. Provider business mailing address

11108 E ASPEN AVE
MESA AZ
85208-8653
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-4086
  • Fax: 480-671-4105
Mailing address:
  • Phone: 602-748-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: