MEDICARE: MRS. JENNIFER ANN BANEK N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP8612	AZ

General Provider Information

NPI Number	:	1255785481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN BANEK N.P.

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	615-706-8357
Fax Number	:	615-523-1910

Provider Business Practice Location Address
First Line	:	2265 W INA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2650
Country	:	US
Telephone Number	:	520-702-3637
Fax Number	:	855-576-4111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	08/27/2025

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