Provider Demographics
NPI:1093712994
Name:ALLISON, JENNIFER A (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:AITKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5150 E GLENN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1337
Mailing Address - Country:US
Mailing Address - Phone:520-795-7729
Mailing Address - Fax:520-795-4177
Practice Address - Street 1:5150 E GLENN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1337
Practice Address - Country:US
Practice Address - Phone:520-795-7729
Practice Address - Fax:520-795-4177
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70617Medicare PIN
AZP61077Medicare UPIN