Healthcare Provider Details

I. General information

NPI: 1104578285
Provider Name (Legal Business Name): JANETTE NICOLE REEVES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21772 S ELLSWORTH LOOP RD
QUEEN CREEK AZ
85142-7709
US

IV. Provider business mailing address

21772 S ELLSWORTH LOOP RD
QUEEN CREEK AZ
85142-7709
US

V. Phone/Fax

Practice location:
  • Phone: 480-512-3700
  • Fax:
Mailing address:
  • Phone: 480-512-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: