Provider Demographics
NPI:1720757032
Name:LIFESPANN ENHANCED SKIN & BODY CARE, PLLC
Entity Type:Organization
Organization Name:LIFESPANN ENHANCED SKIN & BODY CARE, PLLC
Other - Org Name:LIFESPANN PRIMARY CARE & ESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:VALENCIA
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, RRT, LE
Authorized Official - Phone:480-351-7151
Mailing Address - Street 1:2451 E BASELINE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2465
Mailing Address - Country:US
Mailing Address - Phone:480-351-7151
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 310
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2465
Practice Address - Country:US
Practice Address - Phone:480-351-7151
Practice Address - Fax:480-499-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty