Provider Demographics
NPI:1508230269
Name:OPTIMAL HEALTH & HEALING, PLLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH & HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VERONCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP
Authorized Official - Phone:602-705-5117
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
Practice Address - Street 2:SUITE 150
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3188
Practice Address - Country:US
Practice Address - Phone:623-428-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3694363LF0000X
AZNOT YET KNOWN363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty