Provider Demographics
NPI:1023039575
Name:PRESCOTT, JENNIFER MAE (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6094
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-6094
Mailing Address - Country:US
Mailing Address - Phone:480-404-7220
Mailing Address - Fax:
Practice Address - Street 1:14355 MIRANDA WAY
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94022-2032
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841268RN163W00000X
CA363330163W00000X
AZRN138280163W00000X
ARR076739163W00000X
FLRN9504028163W00000X
ARA002911363L00000X
OKR0131163363L00000X
OR200850065NP363L00000X
FLAPRN11001195363L00000X
AZAP2369363LP2300X
CANP9805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN363330Medicaid
CA1023039575Medicaid
AZ352307Medicaid