Healthcare Provider Details

I. General information

NPI: 1942544937
Provider Name (Legal Business Name): JENNIFER MARIE MEJIAS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE CONN RN

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5594 E 22ND ST
TUCSON AZ
85711-5523
US

IV. Provider business mailing address

3042 E WILEY LN
VAIL AZ
85641-9385
US

V. Phone/Fax

Practice location:
  • Phone: 520-232-2047
  • Fax:
Mailing address:
  • Phone: 520-861-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN126561
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5082
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5082
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: