Healthcare Provider Details

I. General information

NPI: 1336050160
Provider Name (Legal Business Name): JASON BOAZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W THOMAS RD
PHOENIX AZ
85037-3332
US

IV. Provider business mailing address

8633 W DAVIS RD
PEORIA AZ
85382-3535
US

V. Phone/Fax

Practice location:
  • Phone: 623-217-3430
  • Fax:
Mailing address:
  • Phone: 623-217-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN160512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: