Healthcare Provider Details

I. General information

NPI: 1871956557
Provider Name (Legal Business Name): JESSICA FLITTIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 E IRMA LN
PHOENIX AZ
85050-4312
US

IV. Provider business mailing address

4375 E IRMA LN
PHOENIX AZ
85050-4312
US

V. Phone/Fax

Practice location:
  • Phone: 480-890-5800
  • Fax:
Mailing address:
  • Phone: 480-890-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN169321
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8596
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: