Healthcare Provider Details

I. General information

NPI: 1093579740
Provider Name (Legal Business Name): BRYNN JENKINS JORGENSEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11075 S STATE ST STE 3
SANDY UT
84070-5165
US

IV. Provider business mailing address

11075 S STATE ST STE 3
SANDY UT
84070-5165
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-9459
  • Fax: 802-494-4742
Mailing address:
  • Phone: 385-335-2654
  • Fax: 802-494-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9043364-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number9043364-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: