Healthcare Provider Details

I. General information

NPI: 1154407666
Provider Name (Legal Business Name): IESHA RASHEDA FLOYD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 W NORTHERN AVE STE B210
PHOENIX AZ
85021-9336
US

IV. Provider business mailing address

2228 W NORTHERN AVE STE B210
PHOENIX AZ
85021-9336
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-1853
  • Fax:
Mailing address:
  • Phone: 480-963-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN134731
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number256272
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: