Healthcare Provider Details

I. General information

NPI: 1063984466
Provider Name (Legal Business Name): JOSEPH GINGO MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2018
Last Update Date: 06/11/2022
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N MAIN ST STE 1B
PRESCOTT VALLEY AZ
86314-1215
US

IV. Provider business mailing address

3555 S VAL VISTA DR
GILBERT AZ
85297-7323
US

V. Phone/Fax

Practice location:
  • Phone: 928-259-5506
  • Fax: 928-441-1463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number178074
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220431
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: