Provider Demographics
NPI:1760038863
Name:DAUGHTERS, MISTY ELAINE (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ELAINE
Last Name:DAUGHTERS
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:ELAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6036 N 19TH AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2143
Mailing Address - Country:US
Mailing Address - Phone:623-738-0193
Mailing Address - Fax:623-745-0801
Practice Address - Street 1:6036 N 19TH AVE STE 502
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2143
Practice Address - Country:US
Practice Address - Phone:623-738-0193
Practice Address - Fax:623-745-0801
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner