Provider Demographics
NPI:1437880713
Name:JSOMAL, FNP PLLC
Entity Type:Organization
Organization Name:JSOMAL, FNP PLLC
Other - Org Name:J. SOMAL AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SOMAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:623-271-2364
Mailing Address - Street 1:41612 N SIGNAL HILL CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24820 N 16TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0643
Practice Address - Country:US
Practice Address - Phone:623-271-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty