Healthcare Provider Details

I. General information

NPI: 1437880713
Provider Name (Legal Business Name): JSOMAL, FNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24820 N 16TH AVE STE 110
PHOENIX AZ
85085-0643
US

IV. Provider business mailing address

41612 N SIGNAL HILL CT
PHOENIX AZ
85086-1913
US

V. Phone/Fax

Practice location:
  • Phone: 623-271-2364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER NICOLE SOMAL
Title or Position: OWNER
Credential: FNP-C
Phone: 623-271-2364