Basic Information
| Provider Information | |||||||||
| NPI: | 1619037827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENA | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2260 N ROSEMONT BLVD | ||||||||
| Address2: | STE 107 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181292 | ||||||||
| FaxNumber: | 5203181338 | ||||||||
| Practice Location | |||||||||
| Address1: | 2260 N ROSEMONT | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181292 | ||||||||
| FaxNumber: | 5203181338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN084171 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 184680 | 05 | AZ | MEDICAID |