Healthcare Provider Details

I. General information

NPI: 1366930794
Provider Name (Legal Business Name): JOYCE MARIE FAUCETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD STE B3
GLENDALE AZ
85306-4638
US

IV. Provider business mailing address

1308 W HAZELWOOD ST
PHOENIX AZ
85013-2648
US

V. Phone/Fax

Practice location:
  • Phone: 602-206-6262
  • Fax: 602-235-0296
Mailing address:
  • Phone: 520-403-3497
  • Fax: 602-235-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11192
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberAP11192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: