Healthcare Provider Details

I. General information

NPI: 1821515032
Provider Name (Legal Business Name): TINA JOY APRN-CNP, FNP-BC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 S BOULEVARD STE 109
EDMOND OK
73013-5514
US

IV. Provider business mailing address

3431 S BOULEVARD STE 109
EDMOND OK
73013-5514
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-1870
  • Fax: 405-562-1871
Mailing address:
  • Phone: 405-562-1870
  • Fax: 405-562-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77055
License Number StateOK

VIII. Authorized Official

Name: MRS. TINA GAY JOY
Title or Position: FAMILY NURSE PRACTITIONER, PROVIDER
Credential: APRN-CNP
Phone: 405-312-2775