Healthcare Provider Details

I. General information

NPI: 1659740462
Provider Name (Legal Business Name): JENNIFER WURSTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER POLSON RN

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 N LA CHOLLA BLVD STE 180
TUCSON AZ
85741-3592
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-3695
  • Fax:
Mailing address:
  • Phone: 520-327-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8110
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: