Healthcare Provider Details

I. General information

NPI: 1508181900
Provider Name (Legal Business Name): JANELLE TYLER POOLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELLE TYLER BARNEY

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5845 E STILL CIR STE 104
MESA AZ
85206-3635
US

IV. Provider business mailing address

20715 E OCOTILLO RD SUITE 102
QUEEN CREEK AZ
85142-6118
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-4000
  • Fax: 623-334-4400
Mailing address:
  • Phone: 480-987-0987
  • Fax: 480-987-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: