Healthcare Provider Details

I. General information

NPI: 1649643727
Provider Name (Legal Business Name): JASON WARREN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

IV. Provider business mailing address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax:
Mailing address:
  • Phone: 480-497-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number323389
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number323389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: