Healthcare Provider Details

I. General information

NPI: 1639756356
Provider Name (Legal Business Name): JACOB PFETSCH FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 E CLARENDON AVE STE 107
PHOENIX AZ
85016-7069
US

IV. Provider business mailing address

3131 E CLARENDON AVE STE 107
PHOENIX AZ
85016-7069
US

V. Phone/Fax

Practice location:
  • Phone: 602-664-8000
  • Fax: 602-664-8001
Mailing address:
  • Phone: 602-664-8000
  • Fax: 602-664-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255950
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: