Healthcare Provider Details

I. General information

NPI: 1386012631
Provider Name (Legal Business Name): JACQUELINE BLANCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37100 N GANTZEL RD STE 201A201B
QUEEN CREEK AZ
85140-7349
US

IV. Provider business mailing address

37100 N GANTZEL RD STE 201A201B
QUEEN CREEK AZ
85140-7349
US

V. Phone/Fax

Practice location:
  • Phone: 480-394-4469
  • Fax: 480-394-4520
Mailing address:
  • Phone: 480-394-4469
  • Fax: 480-394-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number285348
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: