Provider Demographics
NPI:1225381858
Name:AZBILL, JENNIFER LAUREN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:AZBILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3929 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2112
Mailing Address - Country:US
Mailing Address - Phone:602-246-5847
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:3269 STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-757-0645
Practice Address - Fax:386-274-7801
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant