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General NPI Number Information
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NPI Number | 1912769944
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Entity Type | Individual
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Provider Name | JENNIFER SOLOMON AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1944 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5729
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Country | US
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Telephone | 928-405-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 MCCULLOCH BLVD N STE 3A
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-0959
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Country | US
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Telephone | 928-486-6135
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 239721
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 239721
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License Number State | AZ
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