Healthcare Provider Details

I. General information

NPI: 1164703328
Provider Name (Legal Business Name): JOAN M COLLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 202, BLDG C
PROVO UT
84604-8460
US

IV. Provider business mailing address

2000 CIRCLE OF HOPE DR ROOM N1550
SALT LAKE CITY UT
84112-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-2367
  • Fax: 801-429-8015
Mailing address:
  • Phone: 801-213-4270
  • Fax: 801-585-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number369162-4408
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number369162-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: