Healthcare Provider Details

I. General information

NPI: 1386180560
Provider Name (Legal Business Name): JENNA BERNAL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E ELLIOT RD STE 115
TEMPE AZ
85284
US

IV. Provider business mailing address

9506 E NORA CIR
MESA AZ
85207-2555
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN0000179119
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000019546
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: