Provider Demographics
NPI:1225496060
Name:MUHAMMAD, JENNIFER ANN (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E SOUTHERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7507
Mailing Address - Country:US
Mailing Address - Phone:520-477-1815
Mailing Address - Fax:888-376-5279
Practice Address - Street 1:2055 E SOUTHERN AVE STE B
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:520-477-1815
Practice Address - Fax:949-543-2787
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8465363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ138938Medicaid
AZ138938Medicaid