Provider Demographics
NPI:1407337785
Name:WILLFORD, JENNYFER NAYELI (NP)
Entity Type:Individual
Prefix:
First Name:JENNYFER
Middle Name:NAYELI
Last Name:WILLFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:PROF
Other - First Name:JENNYFER
Other - Middle Name:
Other - Last Name:SANDOVAL WILLFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1533 E WILLETTA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2935
Mailing Address - Country:US
Mailing Address - Phone:602-569-3999
Mailing Address - Fax:602-569-3887
Practice Address - Street 1:616 E SOUTHERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4941
Practice Address - Country:US
Practice Address - Phone:602-569-3999
Practice Address - Fax:602-569-3887
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty