=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306099155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON J. JENSEN PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2008
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12361 W BOLA DR STE 109
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-227-1000
-----------------------------------------------------
Fax | 623-227-2000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12361 W BOLA DR STE 109
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-850-0026
-----------------------------------------------------
Fax | 623-850-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5356
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | MA053715
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------