Provider Demographics
NPI:1790530376
Name:MINGOTI, JONATHAN (RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MINGOTI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 N SCOTTSDALE RD APT 3047
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-0142
Mailing Address - Country:US
Mailing Address - Phone:228-365-7152
Mailing Address - Fax:
Practice Address - Street 1:2040 N SCOTTSDALE RD APT 3047
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-0142
Practice Address - Country:US
Practice Address - Phone:228-365-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS919333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse