Provider Demographics
NPI:1912198011
Name:IACOVELLI, JENNIFER ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:IACOVELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9377 E BELL RD STE 313
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1504
Mailing Address - Country:US
Mailing Address - Phone:480-734-7515
Mailing Address - Fax:480-393-7515
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 313
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-734-7515
Practice Address - Fax:480-393-7515
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ435318Medicaid
AZ325467Medicaid
AZ325467Medicaid
AZ325467Medicaid