Provider Demographics
NPI:1578136065
Name:JONES, JAKE ROBERT (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:ROBERT
Last Name:JONES
Suffix:
Gender:M
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 1:12739 W CHUCKS AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7804
Mailing Address - Country:US
Mailing Address - Phone:586-549-2083
Mailing Address - Fax:
Practice Address - Street 1:2806 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3364
Practice Address - Country:US
Practice Address - Phone:586-549-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner