Provider Demographics
NPI:1023039575
Name:PRESCOTT, JENNIFER MAE (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6094
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-6094
Mailing Address - Country:US
Mailing Address - Phone:480-404-7220
Mailing Address - Fax:
Practice Address - Street 1:140 N LITCHFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1226
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-323-8048
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN363330363L00000X
AZRN138280363L00000X
CANP9805363L00000X
AZAP2369363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ352307Medicaid
CA1023039575Medicaid
CARN363330Medicaid