Healthcare Provider Details

I. General information

NPI: 1336775519
Provider Name (Legal Business Name): JENNIFER ANNE ALEXANDER FNP PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 E WHITE ASTER ST
PHOENIX AZ
85044-6781
US

IV. Provider business mailing address

4239 E WHITE ASTER ST
PHOENIX AZ
85044-6781
US

V. Phone/Fax

Practice location:
  • Phone: 603-892-1990
  • Fax:
Mailing address:
  • Phone: 603-892-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239511
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number239511
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: