Healthcare Provider Details

I. General information

NPI: 1841703287
Provider Name (Legal Business Name): JENIFER LYNN CLARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20185 E OCOTILLO RD STE 105
QUEEN CREEK AZ
85142-7663
US

IV. Provider business mailing address

75 W TOWNE RIDGE PKWY STE 500
SANDY UT
84070-5531
US

V. Phone/Fax

Practice location:
  • Phone: 888-209-8874
  • Fax: 833-329-4738
Mailing address:
  • Phone: 801-590-9267
  • Fax: 801-327-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: