Provider Demographics
NPI:1790733764
Name:TETREAULT, JOYCE J (FNP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:J
Last Name:TETREAULT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:J
Other - Last Name:SARHANGIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-1900
Practice Address - Fax:602-933-1918
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2262363LF0000X
AZRN095629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ099465Medicaid