Healthcare Provider Details

I. General information

NPI: 1467547414
Provider Name (Legal Business Name): JENNIFER LINEHAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S ALMA SCHOOL RD STE A206
MESA AZ
85210-3066
US

IV. Provider business mailing address

1930 S ALMA SCHOOL RD STE A206
MESA AZ
85210-3066
US

V. Phone/Fax

Practice location:
  • Phone: 480-779-9050
  • Fax: 480-717-4025
Mailing address:
  • Phone: 480-779-9050
  • Fax: 480-717-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP1171
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP1171
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: