Provider Demographics
NPI:1215365036
Name:AZZALINE, JOYCE (APRN-BC, DHSC)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:AZZALINE
Suffix:
Gender:F
Credentials:APRN-BC, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 DISTINCTIVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9458
Mailing Address - Country:US
Mailing Address - Phone:708-479-5555
Mailing Address - Fax:708-479-5055
Practice Address - Street 1:3033 W JEFFERSON ST STE 201
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5252
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:779-210-5541
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041206875364SP0809X
IL209001842364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult