Healthcare Provider Details

I. General information

NPI: 1205332368
Provider Name (Legal Business Name): JOANNA MAE HUNT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N 19TH AVE STE 102
PHOENIX AZ
85015-3211
US

IV. Provider business mailing address

PO BOX 1045
PHENIX CITY AL
36868-1045
US

V. Phone/Fax

Practice location:
  • Phone: 602-296-5540
  • Fax: 602-296-5442
Mailing address:
  • Phone: 334-291-5255
  • Fax: 887-395-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-113269
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: