Healthcare Provider Details

I. General information

NPI: 1043604804
Provider Name (Legal Business Name): CASSANDRA ANELISE JENKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA ANELISE HUFFMAN

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MONTGOMERY ST STE 810
SAN FRANCISCO CA
94111-2677
US

IV. Provider business mailing address

7820 N PASEO MONSERRAT
TUCSON AZ
85704-1374
US

V. Phone/Fax

Practice location:
  • Phone: 844-847-8216
  • Fax: 415-520-9150
Mailing address:
  • Phone: 520-954-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7690
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: