Healthcare Provider Details

I. General information

NPI: 1073499307
Provider Name (Legal Business Name): LETISHA DRISKELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 N 19TH AVE STE 23
PHOENIX AZ
85029-4825
US

IV. Provider business mailing address

7421 S 23RD DR
PHOENIX AZ
85041-5483
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-3719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194261
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTEMP338183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: