MEDICARE: JACQUELINE TANNER ELLIS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982553772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE TANNER ELLIS

Provider Business Mailing Address
First Line	:	17223 N CAVE CREEK RD UNIT 26
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2484
Country	:	US
Telephone Number	:	928-500-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	17223 N CAVE CREEK RD UNIT 26
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2484
Country	:	US
Telephone Number	:	928-500-8793
Fax Number	:

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

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

Similar Medicare Providers

1982358503 — FUNCTIONAL FUTURES, LLC
Practice Location Address:

13819 N 42ND PL
PHOENIX, AZ
85032-5847

Practice Phone: 480-428-4766
Practice Fax:

1083794465 — RIC RIOS OD PC
Practice Location Address:

12450 N 32ND ST
PHOENIX, AZ
85032-7160

Practice Phone: 602-494-0054
Practice Fax: 602-788-8431

1023977741 — SIMA CAN HELP ARIZONA LLC
Practice Location Address:

3749 E PERSHING AVE
PHOENIX, AZ
85032-6615

Practice Phone: 470-236-9424
Practice Fax:

1730059676 — GINA FELETAR PMHNP-BC
Practice Location Address:

16601 N 40TH ST STE 216
PHOENIX, AZ
85032-3354

Practice Phone: 619-313-3507
Practice Fax:

1790427227 — HIRA ALI DO
Practice Location Address:

3202 E GREENWAY RD STE 1401
PHOENIX, AZ
85032-4511

Practice Phone: 888-405-6396
Practice Fax: 415-252-7176

1386163228 — REGENERATIVE MEDSPA PLLC
Practice Location Address:

16601 N 40TH ST STE 125
PHOENIX, AZ
85032-3355

Practice Phone: 480-292-1735
Practice Fax: 480-383-6516

Directions to “ JACQUELINE TANNER ELLIS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.