MEDICARE: JENNIFER SOLOMON AGNP-C

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	363LA2200X	Adult Health Nurse Practitioner	239721	AZ
2	363LG0600X	Gerontology Nurse Practitioner	239721	AZ

General Provider Information

NPI Number	:	1912769944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SOLOMON AGNP-C

Provider Business Mailing Address
First Line	:	25 RIVIERA BLVD
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5694
Country	:	US
Telephone Number	:	928-505-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1944 MESQUITE AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5729
Country	:	US
Telephone Number	:	928-405-0079
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/05/2026

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