Individual
INA VATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5330 S HIGHWAY 95, FORT MOHAVE, AZ 86426-9225
(928) 788-7077
(469) 249-1170
Mailing address
8612 RANCHO DR, OOLTEWAH, TN 37363-9233
(678) 982-9343
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28976
TN
363LF0000X
Family Nurse Practitioner
Primary
RN168442
GA
Other
Enumeration date
10/24/2017
Last updated
06/18/2026
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