Provider Demographics
NPI:1477284834
Name:DEWITT, JASON (FNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DEWITT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S HIGLEY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2030
Mailing Address - Country:US
Mailing Address - Phone:480-827-5650
Mailing Address - Fax:
Practice Address - Street 1:3126 S HIGLEY RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2030
Practice Address - Country:US
Practice Address - Phone:480-827-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
AZ279807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care