Provider Demographics
NPI:1558986224
Name:BRAY, JODI E (AGNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:BRAY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7236
Mailing Address - Country:US
Mailing Address - Phone:602-263-5242
Mailing Address - Fax:602-595-4434
Practice Address - Street 1:244 N EXTENSION RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6300
Practice Address - Country:US
Practice Address - Phone:602-263-5242
Practice Address - Fax:602-595-4434
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241783363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology