Provider Demographics
NPI:1336477488
Name:ENG, JESSICA (AGACNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ENG
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 EAST CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:480-225-7229
Mailing Address - Fax:
Practice Address - Street 1:1832 EAST CYPRESS STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:480-225-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2023-10-06
Deactivation Date:2023-09-24
Deactivation Code:
Reactivation Date:2023-10-03
Provider Licenses
StateLicense IDTaxonomies
AZLP044342164W00000X
AZ297603363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse