MEDICARE: JACOB ANDREW FIJAL RN

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	163W00000X	Registered Nurse	RN211449	AZ

General Provider Information

NPI Number	:	1598549701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ANDREW FIJAL RN

Provider Business Mailing Address
First Line	:	6131 E 26TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-6020
Country	:	US
Telephone Number	:	520-668-1462
Fax Number	:

Provider Business Practice Location Address
First Line	:	6131 E 26TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-6020
Country	:	US
Telephone Number	:	520-668-1462
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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