Healthcare Provider Details

I. General information

NPI: 1366204638
Provider Name (Legal Business Name): MIA JASINSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST
SCOTTSDALE AZ
85258-4509
US

IV. Provider business mailing address

1003 DUNNING DR
WEST CHESTER PA
19382-7584
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309643
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP029018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: