Provider Demographics
NPI:1891415253
Name:SALAS, JAIMIE RENEE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:RENEE
Last Name:SALAS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:601 11TH AVENUE N
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:480-507-5678
Mailing Address - Fax:480-507-5677
Practice Address - Street 1:2680 S VAL VISTA DR STE 116
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2154
Practice Address - Country:US
Practice Address - Phone:480-507-5678
Practice Address - Fax:480-507-5677
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ156207Medicaid