Healthcare Provider Details

I. General information

NPI: 1831593557
Provider Name (Legal Business Name): JEFFREY DONALD PAUL APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 235
PHOENIX AZ
85037-3363
US

IV. Provider business mailing address

5505 W STRAIGHT ARROW LN
PHOENIX AZ
85083-9311
US

V. Phone/Fax

Practice location:
  • Phone: 623-327-7131
  • Fax:
Mailing address:
  • Phone: 630-688-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9905
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP9905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: