Healthcare Provider Details

I. General information

NPI: 1194369421
Provider Name (Legal Business Name): JENNIFER LA FRANCE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 478
PHOENIX AZ
85037-3375
US

IV. Provider business mailing address

2541 N 125TH DR
AVONDALE AZ
85392-5539
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-8507
  • Fax:
Mailing address:
  • Phone: 623-826-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228199
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: