Provider Demographics
NPI:1700110434
Name:HECK, JOANNA L (NP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:HECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 E. BANNER GATEWAY DRIVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-3430
Mailing Address - Fax:480-256-3682
Practice Address - Street 1:1900 N. HIGLEY ROAD BANNER GATEWAY MEDICAL CENTER,
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-256-3430
Practice Address - Fax:480-256-3682
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA011021NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016239Medicaid
OHHENP33121Medicare PIN