Provider Demographics
NPI:1114450962
Name:LAY, JODI LYN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYN
Last Name:LAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4494 W PEORIA AVE STE 115A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2020
Mailing Address - Country:US
Mailing Address - Phone:602-509-9177
Mailing Address - Fax:
Practice Address - Street 1:5700 W OLIVE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3147
Practice Address - Country:US
Practice Address - Phone:623-387-3705
Practice Address - Fax:866-941-5662
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10016363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine