MEDICARE: JENIFER LYNN CLARK FNP

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	AP10668	AZ

General Provider Information

NPI Number	:	1841703287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER LYNN CLARK FNP

Provider Business Mailing Address
First Line	:	75 W TOWNE RIDGE PKWY STE 500
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-5531
Country	:	US
Telephone Number	:	801-590-9267
Fax Number	:	801-327-0211

Provider Business Practice Location Address
First Line	:	20185 E OCOTILLO RD STE 105
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-7663
Country	:	US
Telephone Number	:	888-209-8874
Fax Number	:	833-329-4738

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

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	06/08/2026

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