Provider Demographics
NPI:1851609309
Name:ENGHOLDT, JAIME L (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:ENGHOLDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 W CAREFREE HWY STE 1-132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3260
Mailing Address - Country:US
Mailing Address - Phone:480-622-0548
Mailing Address - Fax:
Practice Address - Street 1:3120 W CAREFREE HWY STE 1-132
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3260
Practice Address - Country:US
Practice Address - Phone:480-622-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant