Provider Demographics
NPI:1023652039
Name:BARAJAS, JABEZ (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JABEZ
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE BLDG H146
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-649-1555
Mailing Address - Fax:602-649-1554
Practice Address - Street 1:18275 N 59TH AVE BLDG H146
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-649-1555
Practice Address - Fax:602-649-1554
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP234219363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care