Provider Demographics
NPI:1588455968
Name:MARY JACQUELINE FNP-C-PC
Entity type:Organization
Organization Name:MARY JACQUELINE FNP-C-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-726-6772
Mailing Address - Street 1:2281 W 24TH ST STE 15
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6197
Mailing Address - Country:US
Mailing Address - Phone:928-726-6772
Mailing Address - Fax:928-726-3012
Practice Address - Street 1:2281 W 24TH ST STE 15
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-726-6772
Practice Address - Fax:928-726-3012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty