Healthcare Provider Details

I. General information

NPI: 1760752562
Provider Name (Legal Business Name): JUANITA M CREWS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ESTRELLA PKWY SUITE #6521
GOODYEAR AZ
85338
US

IV. Provider business mailing address

8856 S 166TH AVENUE
GOODYEAR AZ
85338
US

V. Phone/Fax

Practice location:
  • Phone: 904-608-3868
  • Fax:
Mailing address:
  • Phone: 904-608-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP342124
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN143944
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: