1659440733 NPI number — PATRICIA E JOST FNP

Table of content: PATRICIA E JOST FNP (NPI 1659440733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659440733 NPI number — PATRICIA E JOST FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOST
Provider First Name:
PATRICIA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659440733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 56765
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-6765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-406-3860
Provider Business Mailing Address Fax Number:
602-406-6162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W THOMAS RD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-3172
Provider Business Practice Location Address Fax Number:
602-406-3738
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN033766 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 686864 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".