MEDICARE: MR. MICHAEL DEREK JAORASDR APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	219543	AZ
2	363LF0000X	Family Nurse Practitioner	219543	AZ

General Provider Information

NPI Number	:	1851697007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DEREK JAORASDR APRN, FNP-C

Provider Business Mailing Address
First Line	:	100 E CAMELBACK RD STE 108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1061
Country	:	US
Telephone Number	:	602-796-9867
Fax Number	:	480-664-6153

Provider Business Practice Location Address
First Line	:	100 E CAMELBACK RD STE 108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1061
Country	:	US
Telephone Number	:	602-354-3925
Fax Number	:	602-354-3768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/11/2024

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