Healthcare Provider Details

I. General information

NPI: 1053746503
Provider Name (Legal Business Name): JOHN ANDREW PROSSER JR. MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W BASELINE RD SUITE 111
PHOENIX AZ
85041-6492
US

IV. Provider business mailing address

4600 S MILL AVE STE 280
TEMPE AZ
85282-6850
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-677-8283
Mailing address:
  • Phone: 480-305-2888
  • Fax: 480-305-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5143
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: