Provider Demographics
NPI:1073963922
Name:ARAGON, JENNIFER LYN (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:ARAGON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:JACQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9980 S 300 W STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3654
Mailing Address - Country:US
Mailing Address - Phone:385-495-4151
Mailing Address - Fax:
Practice Address - Street 1:9980 S 300 W STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3654
Practice Address - Country:US
Practice Address - Phone:385-495-4151
Practice Address - Fax:844-596-0409
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290041-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1457556243Medicaid