Provider Demographics
NPI:1184186595
Name:HYATT, JOYCE ELLEN (F320005)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ELLEN
Last Name:HYATT
Suffix:
Gender:F
Credentials:F320005
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ELLEN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-7948
Mailing Address - Country:US
Mailing Address - Phone:607-562-8403
Mailing Address - Fax:
Practice Address - Street 1:36 MEADOW DR
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-7948
Practice Address - Country:US
Practice Address - Phone:607-562-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF320005363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health