# HEARTFIT FOR DUTY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295009561
- **Authorized official:** MRS. KEPRA L JACK RN (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (602) 402-5090

## Contact information

- **Practice address:** 633 E RAY RD, SUITE 101, GILBERT, AZ 85296-4200
- **Practice address phone:** (480) 999-7911
- **Practice address fax:** (480) 499-5829
- **Mailing address:** 4192 E PALM BEACH DR, CHANDLER, AZ 85249-7398
- **Mailing address phone:** (602) 402-5090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | AP3059 | AZ | — |

## Other

- **Enumeration date:** 03/02/2012
- **Last updated:** 04/02/2013