Provider Demographics
NPI:1326432501
Name:JONES, NICOLE MARIA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:130 S 63RD ST
Mailing Address - Street 2:STE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1620
Mailing Address - Country:US
Mailing Address - Phone:480-773-2220
Mailing Address - Fax:480-452-0533
Practice Address - Street 1:130 S 63RD ST
Practice Address - Street 2:STE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1620
Practice Address - Country:US
Practice Address - Phone:480-773-2220
Practice Address - Fax:480-452-0533
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7711363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care