Provider Demographics
NPI:1669495206
Name:PRATT, JAYNE GINKUS (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:GINKUS
Last Name:PRATT
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:MS
Other - First Name:JAYNE
Other - Middle Name:SUSAN
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-773-2048
Mailing Address - Fax:
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3118
Practice Address - Country:US
Practice Address - Phone:928-773-2048
Practice Address - Fax:928-773-2416
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 0969162 FL363LF0000X
AZAP5302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM3562Medicare UPIN
FLAM356ZMedicare PIN