Provider Demographics
NPI:1881044147
Name:EASTMAN, JOANN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 S CRISMON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6216
Mailing Address - Country:US
Mailing Address - Phone:480-610-7100
Mailing Address - Fax:
Practice Address - Street 1:1917 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6216
Practice Address - Country:US
Practice Address - Phone:480-610-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60911805363LF0000X
AZAP60911805363LF0000X
AZAP8759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN090351OtherREGISTERED NURSE
WAAP60911805OtherADVANCED REGISTERED NURSE PRACTITIONER LICENSE
WARN60896196OtherREGISTERED NURSE LICENSE
AZAP8759OtherADVANCED REGISTERED NURSE PRACTIONER