Provider Demographics
NPI:1134532963
Name:SQUIRES-JACOBELLI, TERRY DENISE (NP)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:DENISE
Last Name:SQUIRES-JACOBELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3012
Mailing Address - Country:US
Mailing Address - Phone:480-833-4277
Mailing Address - Fax:480-833-4277
Practice Address - Street 1:5225 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7005
Practice Address - Country:US
Practice Address - Phone:888-371-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily