Active NPI
Janna Ellsworth
- Family Nurse Practitioner
- Queen Creek, AZ
National Provider Identifier
1093429243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F12220690
- Practice address
- 18643 E Oriole Way
Queen Creek, AZ 85142-5540 - Phone
- (928) 242-4696
- NPI assigned
- Jan 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F12220690 | AZ | Primary |
Addresses
Primary practice location
18643 E Oriole Way
Queen Creek, AZ 85142-5540
Mailing address
18643 E Oriole Way
Queen Creek, AZ 85142-5540
Phone (928) 242-4696
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F12220690 | AZ | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673481600000",
"number": "1093429243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18643 E ORIOLE WAY",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851425540",
"telephone_number": "928-242-4696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18643 E ORIOLE WAY",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851425540",
"telephone_number": "928-242-4696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "JANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-12",
"last_updated": "2023-01-12",
"certification_date": "2023-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "F12220690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queen Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.