Provider Demographics
NPI:1457654329
Name:SANCHEZ, JACQUELYN SUZANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:SUZANNE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JACQUELYN
Other - Middle Name:SUZANNE
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1248 S CHOLLA CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-0921
Mailing Address - Country:US
Mailing Address - Phone:520-794-1687
Mailing Address - Fax:
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-345-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily