Jetta Derasin
Nurse Practitioner Family Doctor - Addiction Medicine Nurse Practitioner - Primary Care Nurse Practitioner - Family Medicine
1705 W Main St
Mesa
, Arizona 85201
Jetta Derasin
Nurse Practitioner Family Doctor - Addiction Medicine Nurse Practitioner - Primary Care Nurse Practitioner - Family Medicine
1705 W Main St
Mesa
, Arizona 85201
(623) 974-6721
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About
Features
Specialties
- Family Doctor - Addiction Medicine
- Nurse Practitioner
- Nurse Practitioner - Family Medicine
- Nurse Practitioner - Primary Care
Languages spoken
- English
Location
First Address
- Jetta Derasin
- 3033 N Central Ave Ste 145
- Phoenix, AZ
- Zip : 85012-2808
- Fax : (623) 974-6721
- Phone : (623) 583-3001
Second Address
- Jetta Derasin
- 1705 W Main St
- Mesa, AZ
- Zip : 85201
- Fax : (480) 718-9477
- Phone : (877) 809-5092
Reviews
FAQs
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Where did Jetta Derasin do her fellowship?
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What type of doctor is Jetta Derasin
In what state does Jetta Derasin practice in?
Where is Jetta Derasin ’s practice located?
What is Jetta Derasin ’s gender?
Is Jetta Derasin a sole practitioner?
Is Jetta Derasin accepting new patients?
What languages does Jetta Derasin speak?
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Does Jetta Derasin have any license restrictions?
Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0401X | Family Doctor - Addiction Medicine | AP10652 | AZ |
| N | 363L00000X | Nurse Practitioner | 66001 | WV |
| N | 363LF0000X | Nurse Practitioner - Family Medicine | 3007628 | KY |
| N | 363LP2300X | Nurse Practitioner - Primary Care | AP10652 | AZ |
National Provider Identifier
| NPI | 1720336910 |
|---|---|
| Provider Name | Jetta Derasin |
| First Address | Phoenix, AZ 85012-2808 |
| Second Address | Mesa, AZ 85201 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2012 |
| Last Update Date | 29/01/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0072341 | (05) | OH |
| 204924 | (05) | AZ |
| 3810025120 | (05) | WV |
| 7100218950 | (05) | KY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.