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General NPI Number Information
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NPI Number | 1134532963
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Entity Type | Individual
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Provider Name | TERRY DENISE SQUIRES-JACOBELLI N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 5225 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-7005
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Country | US
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Telephone | 888-371-5376
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 E CAROL AVE
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City | MESA
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State | AZ
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Zip | 85204-3012
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Country | US
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Telephone | 480-833-4277
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Fax | 480-833-4277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP5385
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License Number State | AZ
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