Healthcare Provider Details

I. General information

NPI: 1356274849
Provider Name (Legal Business Name): JENNIFER LYNN COOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14659 W ACAPULCO LN
SURPRISE AZ
85379-8527
US

IV. Provider business mailing address

14659 W ACAPULCO LN
SURPRISE AZ
85379-8527
US

V. Phone/Fax

Practice location:
  • Phone: 623-238-2224
  • Fax:
Mailing address:
  • Phone: 623-238-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN206598
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: