Healthcare Provider Details

I. General information

NPI: 1003587809
Provider Name (Legal Business Name): MACY JO JERNIGAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W. THUNDERBIRD BLVD SUITE 300
SUN CITY AZ
85351
US

IV. Provider business mailing address

10401 W THUNDERBIRD BLVD STE 300
SUN CITY AZ
85351-3004
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-7211
  • Fax: 480-256-3682
Mailing address:
  • Phone: 623-977-7211
  • Fax: 480-256-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: