Healthcare Provider Details

I. General information

NPI: 1871592147
Provider Name (Legal Business Name): LESLEE JOAN TESTA RNC, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 W BELL RD
GLENDALE AZ
85308-3530
US

IV. Provider business mailing address

4319 W BELL RD
GLENDALE AZ
85308-3530
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-0448
  • Fax:
Mailing address:
  • Phone: 602-888-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN087497
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN087497
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1258
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: