Healthcare Provider Details

I. General information

NPI: 1982176301
Provider Name (Legal Business Name): JONELL CONN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 E CORONADO RD STE 201
PHOENIX AZ
85004-1583
US

IV. Provider business mailing address

337 E CORONADO RD STE 201
PHOENIX AZ
85004-1583
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-4600
  • Fax:
Mailing address:
  • Phone: 480-712-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN220410
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: