Provider Demographics
NPI:1538460001
Name:LAFORTE, JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LAFORTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S CLEARVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-988-9108
Mailing Address - Fax:480-813-4460
Practice Address - Street 1:6501 E GREENWAY PKWY
Practice Address - Street 2:SUITE 3-104
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2065
Practice Address - Country:US
Practice Address - Phone:480-948-3314
Practice Address - Fax:480-948-3588
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z157664OtherMEDICARE PTAN
AZ599849Medicaid