Basic Information
| Provider Information | |||||||||
| NPI: | 1629473236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15715 S 46TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804966444 | ||||||||
| FaxNumber: | 4804969688 | ||||||||
| Practice Location | |||||||||
| Address1: | 15715 S 46TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804966444 | ||||||||
| FaxNumber: | 4804969688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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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 | AP7370 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.