Healthcare Provider Details

I. General information

NPI: 1790645570
Provider Name (Legal Business Name): JENNIFER JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 W THUNDERBIRD RD
PEORIA AZ
85381-4822
US

IV. Provider business mailing address

28037 N VIA DONNA RD
PHOENIX AZ
85085-4718
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-3006
  • Fax:
Mailing address:
  • Phone: 623-377-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: