=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437880713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JSOMAL, FNP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2022
-----------------------------------------------------
Last Update Date | 10/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24820 N 16TH AVE STE 110
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85085-0643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-271-2364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41612 N SIGNAL HILL CT
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JENNIFER NICOLE SOMAL
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 623-271-2364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------