Healthcare Provider Details

I. General information

NPI: 1275513723
Provider Name (Legal Business Name): JOYCE-NICOLE PACHENCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 05/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N. 22ND ST.
PHOENIX AZ
85016
US

IV. Provider business mailing address

4800 N 22ND ST
PHOENIX AZ
85016-4701
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-1000
  • Fax:
Mailing address:
  • Phone: 602-955-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: