Provider Demographics
NPI:1073544482
Name:MAXFIELD, JOAN M (RN-C, FNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:RN-C, FNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-C, FNP
Mailing Address - Street 1:601A MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1214
Mailing Address - Country:US
Mailing Address - Phone:512-352-7811
Mailing Address - Fax:512-352-4734
Practice Address - Street 1:305 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1208
Practice Address - Country:US
Practice Address - Phone:512-352-7811
Practice Address - Fax:512-352-4734
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039599801Medicaid
81N491Medicare ID - Type Unspecified
TX039599801Medicaid