Healthcare Provider Details

I. General information

NPI: 1083776785
Provider Name (Legal Business Name): NASRIN JAZAYERI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 E MAIN ST
MESA AZ
85205-8605
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-7500
  • Fax: 480-906-2173
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN057391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: