Healthcare Provider Details

I. General information

NPI: 1649628280
Provider Name (Legal Business Name): JENNY HAAG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 E CHANDLER BLVD STE 42
PHOENIX AZ
85048-8832
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 888-316-1686
Mailing address:
  • Phone: 480-677-8282
  • Fax: 888-316-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: