Healthcare Provider Details

I. General information

NPI: 1699416917
Provider Name (Legal Business Name): JENNIFER NICOLE SOMAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 04/02/2022
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 W DEER VALLEY RD STE 125
PEORIA AZ
85382-2102
US

IV. Provider business mailing address

41612 N SIGNAL HILL CT
PHOENIX AZ
85086-1913
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-6300
  • Fax:
Mailing address:
  • Phone: 623-271-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number273314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: