Provider Demographics
NPI:1205004876
Name:VALENTINE, JENNIFER LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD STE 127
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2388
Mailing Address - Country:US
Mailing Address - Phone:623-931-3028
Mailing Address - Fax:623-931-3029
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 127
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2388
Practice Address - Country:US
Practice Address - Phone:623-931-3028
Practice Address - Fax:623-931-3029
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN085402363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ719586Medicaid