Provider Demographics
NPI:1124335666
Name:EMAMI, JOLEEN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:MARIE
Last Name:EMAMI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4236
Mailing Address - Country:US
Mailing Address - Phone:520-248-0615
Mailing Address - Fax:
Practice Address - Street 1:707 N ALVERNON WAY STE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1847
Practice Address - Country:US
Practice Address - Phone:520-694-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN131378163W00000X
AZAP3692363LF0000X
AZTAP3692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ548172Medicaid
Z174074OtherMEDICARE PTAN
Z174074OtherMEDICARE PTAN