Provider Demographics
NPI:1487199824
Name:MILES, JENNY WINSLOW (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:WINSLOW
Last Name:MILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E CAMELBACK RD
Mailing Address - Street 2:150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 E CAMELBACK RD
Practice Address - Street 2:150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2614
Practice Address - Country:US
Practice Address - Phone:602-368-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF1216090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF1216090OtherFAMILY NURSE PRACTITIONER