Provider Demographics
NPI:1669523510
Name:FONTANA, JOYCE (PHD NP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:PHD NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 KING MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6498
Mailing Address - Country:US
Mailing Address - Phone:970-375-7100
Mailing Address - Fax:
Practice Address - Street 1:549 KING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6498
Practice Address - Country:US
Practice Address - Phone:970-375-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23458038Medicaid
CO454138Medicare ID - Type Unspecified
COP46580Medicare UPIN