Provider Demographics
NPI:1407226285
Name:BALBOA-AZURA, JOSIE JOY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSIE JOY
Middle Name:
Last Name:BALBOA-AZURA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7280
Mailing Address - Country:US
Mailing Address - Phone:623-374-7774
Mailing Address - Fax:888-632-4758
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4799
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:888-632-4758
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily