Healthcare Provider Details

I. General information

NPI: 1609542372
Provider Name (Legal Business Name): JENNIFER HERRERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21029 W MAIN ST
BUCKEYE AZ
85396-3527
US

IV. Provider business mailing address

18950 W DESERT HILLS DR
SURPRISE AZ
85388-3272
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-6404
  • Fax: 623-213-8541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262615
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: