MEDICARE: ADVANTAGE PRIMARY HEALTH

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

General Provider Information

NPI Number	:	1740138064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE PRIMARY HEALTH

Provider Business Mailing Address
First Line	:	6546 E 2ND ST STE C
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-3540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6546 E 2ND ST STE C
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-3540
Country	:	US
Telephone Number	:	928-899-3461
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JEREMY PENE
Credential	:	NP
Telephone Number	:	928-899-3461

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ADVANTAGE PRIMARY HEALTH ” Practice Location

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