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NPI Code Detail

MEDICARE: JACOB ANDREW FIJAL FNP

MEDICARE: JACOB ANDREW FIJAL FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN211449AZ
2363LF0000XFamily Nurse Practitioner335530AZ

General Provider Information

NPI Number : 1598549701
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB ANDREW FIJAL FNP
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 06/01/2026

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