Healthcare Provider Details

I. General information

NPI: 1184515249
Provider Name (Legal Business Name): VITAL HORMONES AND WEIGHT LOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21455 S ELLSWORTH RD
QUEEN CREEK AZ
85142-9849
US

IV. Provider business mailing address

22591 S 225TH WAY
QUEEN CREEK AZ
85142-5678
US

V. Phone/Fax

Practice location:
  • Phone: 480-318-1823
  • Fax:
Mailing address:
  • Phone: 480-318-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HULS
Title or Position: OWNER/PROVIDER
Credential: FNP-BC
Phone: 480-318-1823