Healthcare Provider Details

I. General information

NPI: 1093065385
Provider Name (Legal Business Name): JARED THOMAS THORLEY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 CIRCLE OF HOPE CLINIC 2B
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

127 S 500 E STE 600
SALT LAKE CITY UT
84102-1971
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0100
  • Fax: 801-585-0721
Mailing address:
  • Phone: 801-587-6705
  • Fax: 801-715-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7094888-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: