Provider Demographics
NPI:1962570770
Name:BRACEWELL, JOANNE (ARNP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:BRACEWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:5840 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3537
Practice Address - Country:US
Practice Address - Phone:520-498-3900
Practice Address - Fax:520-544-7542
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1253402363LP2300X
AZ234659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1253402OtherMEDICAL LICENSE
GARN 217510OtherSTATE OF GEORGIA NP LICENSE
FL304924800Medicaid
FL304924800Medicaid
GARN 217510OtherSTATE OF GEORGIA NP LICENSE