Individual
JENNICA LINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2487 S GILBERT RD # 106-123, GILBERT, AZ 85295-8899
(480) 256-2696
Mailing address
2487 S GILBERT RD # 106-123, GILBERT, AZ 85295-8899
(480) 256-2696
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-87926
NM
163W00000X
Registered Nurse
RN176538
AZ
363LF0000X
Family Nurse Practitioner
Primary
28861
AZ
363LF0000X
Family Nurse Practitioner
56879
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730751208
—
NM
Enumeration date
07/03/2019
Last updated
08/03/2026
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