Provider Demographics
NPI:1659512630
Name:HUNT, JACKOLYN SUE (RNNNP)
Entity Type:Individual
Prefix:MRS
First Name:JACKOLYN
Middle Name:SUE
Last Name:HUNT
Suffix:
Gender:F
Credentials:RNNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 N. 16TH ST.
Mailing Address - Street 2:SUITE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4401
Mailing Address - Country:US
Mailing Address - Phone:623-643-9235
Mailing Address - Fax:623-643-9236
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:NEONATOLOGY DEPARTMENT
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4622
Practice Address - Country:US
Practice Address - Phone:602-865-5915
Practice Address - Fax:602-865-5935
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ026766363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444578Medicaid