Healthcare Provider Details

I. General information

NPI: 1013687011
Provider Name (Legal Business Name): JENNIFER DUFFY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3590
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3590
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8575
  • Fax: 505-292-8409
Mailing address:
  • Phone: 505-292-8575
  • Fax: 505-292-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65248
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: