Healthcare Provider Details

I. General information

NPI: 1114590296
Provider Name (Legal Business Name): JOY HOLBROOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 1050 N
HEBER CITY UT
84032-3475
US

IV. Provider business mailing address

1680 E 1050 N
HEBER CITY UT
84032-3475
US

V. Phone/Fax

Practice location:
  • Phone: 801-368-4322
  • Fax:
Mailing address:
  • Phone: 801-368-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number376725-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number376725-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: