Provider Demographics
NPI:1831318401
Name:VARGAS, JENNIFER DALESSANDRO (WHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DALESSANDRO
Last Name:VARGAS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DALESSANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:PO BOX 910221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0221
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:2625 N CRAYCROFT RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2268
Practice Address - Country:US
Practice Address - Phone:520-416-5602
Practice Address - Fax:520-323-0076
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2647363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ216734Medicaid