Provider Demographics
NPI:1760193775
Name:FERRIS, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 S 59TH AVE STE A105
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3071
Mailing Address - Country:US
Mailing Address - Phone:602-476-8888
Mailing Address - Fax:602-563-3827
Practice Address - Street 1:7650 S 59TH AVE STE A105
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3071
Practice Address - Country:US
Practice Address - Phone:602-476-8888
Practice Address - Fax:602-563-3827
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical