Provider Demographics
NPI:1457662165
Name:FOX, VERONCIA JEANNE (MSN, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VERONCIA
Middle Name:JEANNE
Last Name:FOX
Suffix:
Gender:F
Credentials:MSN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 W TWAIN CT
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1671
Mailing Address - Country:US
Mailing Address - Phone:602-705-5117
Mailing Address - Fax:520-306-4877
Practice Address - Street 1:41818 N VENTURE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3190
Practice Address - Country:US
Practice Address - Phone:602-903-6551
Practice Address - Fax:520-306-4877
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8518363LP0808X
AZAP3694363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ603914Medicaid
AZZ183303Medicare PIN