Basic Information
Provider Information
NPI: 1982180154
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LLOYD
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2730 E 3220 S
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841092815
CountryCode: US
TelephoneNumber: 7193397625
FaxNumber:  
Practice Location
Address1: 1950 CIRCLE OF HOPE DR
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841125500
CountryCode: US
TelephoneNumber: 8015877000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2018
LastUpdateDate: 11/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X9484034-4405UTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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